August 20, 2007

Coding for Benign Lung Neoplasms
For The Record
Vol. 19 No. 17 P. 37

A lung neoplasm is a noncancerous cell mass that has formed due to excessive cell division. These neoplasms grow slowly and do not metastasize. Although not harmful, benign neoplasms may become large, causing pressure on nearby blood vessels, nerves, or organs. Lung cancer is any type of malignant growth in the lungs, occurring when cells in the lung start to grow rapidly in an uncontrolled manner.

Types of Lung Neoplasms
The following are types of benign lung neoplasms:

• bronchial adenomas;

• hamartomas (chondroadenomas);

• chondromas;

• fibromas;

• lipomas;

• leiomyomas;

• hemangiomas;

• teratomas;

• pseudolymphomas;

• endometriosis; and

• bronchial glomus tumors.

Although these are listed as benign lung neoplasms, they may be considered cancerous. Therefore, code assignment will depend on the physician documentation in the body of the medical record.

Regardless of the cell type, benign lung neoplasm is classified to ICD-9-CM code 212.3. Primary malignant neoplasm of the lung is classified to code 162.x with the fourth digit subcategory identifying the specified site of the cancer such as the following:

• 162.0, Trachea;

• 162.2, Main bronchus;

• 162.3, Upper lobe, bronchus or lung;

• 162.4, Middle lobe, bronchus or lung;

• 162.5, Lower lobe, bronchus or lung;

• 162.8, Other parts of bronchus or lung—includes malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined; and

• 162.9, Bronchus and lung, unspecified.

Carcinoma in situ of the lung is classified to code 231.2. Lung neoplasm of uncertain behavior is assigned to code 235.7, and code 239.1 is for unspecified nature. If the lung cancer is considered a metastatic site—the cancer spread from another organ to the lung—code 197.0 is assigned.

Symptoms
A patient with a benign lung neoplasm may present with the following symptoms:

• hemoptysis;

• wheezing;

• persistent coughing; and/or

• shortness of breath.

Some types of benign lung neoplasms are asymptomatic.

Diagnosis
The following exams and tests may be performed to diagnose lung cancer:

• physical exam, which may identify diminished breath sounds, dullness to percussion, and rales;

• chest x-ray to identify a lung mass; or

• biopsy, which confirms cell type and whether the mass is malignant or benign. The biopsy may be performed though a bronchoscopy (33.24), percutaneous needle biopsy (33.26), or thoracoscopy (33.26, if by needle, or 33.28). Transbronchial lung biopsy (33.27) is when the bronchoscope biopsy forceps actually punctures the terminal bronchus and samples of the peribronchial alveoli (lung tissue) are taken. The coder should read the operative report completely to determine the procedure performed prior to code assignment.

Treatment
Noncancerous bronchial tumors are typically surgically excised because they may block the bronchi and become cancerous. Lung cancer treatment depends on the size, location, stage, and type of cancer, as well as the individual’s overall health. Surgery, radiation therapy, and chemotherapy may be used alone or in various combinations to threat lung cancer. Surgery may be the option of choice when the cancer is confined to a limited area.

Coding and sequencing for benign lung neoplasms are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.