October 27, 2008

Neoplasm Guidelines
For The Record
Vol. 20 No. 22 P. 28

The ICD-9-CM Official Guidelines for Coding and Reporting was updated effective October 1, 2008. The neoplasm guidelines, among others, were updated. Coders often have questions about the coding and proper sequencing of neoplasms, so below is a summary of the common neoplasm rules and guidelines.

Neoplasm Coding Guidelines
• Designate the malignancy as the principal diagnosis when the treatment is directed toward the malignancy. However, if a patient is admitted solely for the administration of chemotherapy, immunotherapy, or radiation therapy, assign a code from category V58 as the principal diagnosis and the malignancy as the secondary diagnosis.

• Designate the secondary site neoplasm as the principal diagnosis when the treatment is directed only toward the secondary (metastatic) neoplasm even though the primary site is still present. If the treatment is directed equally toward both the primary and secondary sites, assign the primary malignancy as the principal diagnosis (AHA ICD-9-CM Coding Handbook, Faye Brown, 2004, page 300).

• Sequence anemia as the principal diagnosis when the admission is for the management of anemia associated with the malignancy or the therapy and the treatment is only directed at the anemia. The anemia code assignment will depend on the specific type of anemia documented. Code 285.22, Anemia in neoplastic disease, is used for anemia due to malignancy. Do not use code 285.22 for anemia that is due to antineoplastic chemotherapy drugs.

• Sequence dehydration as the principal diagnosis when the admission is for the management of dehydration due to the malignancy or the therapy and only the dehydration is being treated.

• When the admission is for the treatment of a complication resulting from a surgical procedure, sequence the complication as the principal diagnosis if treatment is directed at resolving the complication.

• When the primary malignancy has been previously excised or eradicated from its site and there is no adjunct treatment directed at that site and no evidence of any remaining malignancy at the primary site, use the appropriate code from category V10, Personal history of malignant neoplasm, to indicate the former site of the primary malignancy. Documentation of the extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The metastatic site may be sequenced as the principal diagnosis if treatment is directed toward the metastatic site.

• Sequence the malignancy as the principal diagnosis when the patient is admitted for the surgical removal of a malignancy followed by chemotherapy or radiation therapy. If the patient is admitted solely for the purpose of receiving chemotherapy, immunotherapy, or radiotherapy, sequence code V58.11 (Admit for chemotherapy), V58.12 (Admit for immunotherapy), or V58.0 (Admit for radiotherapy) as the principal diagnosis.

• Sequence the malignancy (either the primary or secondary) as the principal diagnosis if the patient is admitted to determine the extent of the malignancy (staging) or for a procedure such as thoracentesis or paracentesis even though chemotherapy or radiation therapy is administered.

• Sequence the malignancy as the principal diagnosis when the patient is admitted with signs and symptoms related to the malignancy.

• A malignant neoplasm of a transplanted organ is assigned to a code from subcategory 996.8, Complications of a transplanted organ, and code 199.2, Malignant neoplasm associated with transplanted organ. Also, assign a code for the specific malignancy.

Other Neoplasm Coding Directives
• If a patient is admitted with a nonneoplastic condition for chemotherapy or immunotherapy, assign the condition as the principal diagnosis. Do not assign code V58.11 or V58.12. For example, a patient is admitted for chemotherapy to treat macroglobulinemia. Assign code 273.3; do not assign code V58.11.

• If the patient is admitted for a radioactive implant, assign the malignancy as the principal diagnosis; do not assign code V58.0.

• Assign a code for the malignancy if a patient is receiving treatment (eg, chemotherapy) for a malignancy that has already been excised. Do not assign a code from category V10, Personal history of malignant neoplasm, because the patient would not still be under treatment if the malignancy were actually a history of malignancy.
 
Coding and sequencing for 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 more than 4,000 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.