9Chapter Nine

Neoplasms

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Learning Outcomes

• After completing this chapter, you will be able to:

– LO 9.1 Apply general neoplasm coding guidelines.

– LO 9.2 Discuss aspects of coding malignant neoplasms.

– LO 9.3 Identify terms used to document in situ neoplasms.

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Learning Outcomes (cont.)

– LO 9.4 Classify conditions related to benign neoplasms.

– LO 9.5 Describe neoplasms of uncertain behavior and neoplasms of unspecified behavior.

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Key Terms

• benign

• Bowen’s disease

• carcinomatosis

• disseminated malignant neoplasm

• dysplasia

• functional activity

• hemangioma

• histologic type

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• Hodgkin lymphoma

• in situ

• International Classification

of Diseases for Oncology

(ICD-O)

• Kaposi’s sarcoma

• leukemia

• lymphangioma

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Key Terms (cont.)

• lymphoma

• malignant

• metastasis

• morphology

• multiple myeloma

• neoplasm

• Neoplasms Table

• nevus

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• neuroendocrine tumors

• primary

• remission

• secondary

• topography

• uncertain behavior

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9.1 General Neoplasm Coding Guidelines

• Chapter 2 classification of neoplasms regardless of functional activity

• Neoplasms are classified by topography

• Neoplasms Table

• International Classification of Disease for Oncology (ICD-O) – MORPHOLOGY

• Chemotherapy, immunotherapy, radiation therapy

• Complications of neoplasms

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9.1 General Neoplasm Coding Guidelines

Table 9.1: Sample of Neoplasm Table

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Malignant Primary

Malignant Secondary

Ca in situ

Benign Uncertain Behavior

Unspecified Behavior

abdomen, abdominal C76.2 C79.8 D09.8 D36.7 D48.7 D49.89 cavity C76.2 C79.8 D09.8 D36.7 D48.7 D49.89 organ C76.2 C79.8 D09.8 D36.7 D48.7 D49.89 viscera C76.2 C79.8 D09.8 D36.7 D48.7 D49.89 wall C44.59 C79.2 D04.5 D23.5 D48.5 D49.2

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9.1 General Neoplasm Coding Guidelines

• Primary vs. secondary

• Sequencing

• History vs. remission

• Coding guidelines I.C.2. Neoplasms

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9.2 Malignant Neoplasms

• C00-C96 Malignant neoplasms• Examples of sites:

• Mesothelial tissue

• Hematopoietic tissue

• Lymphoid tissue

• Body organs

• Corresponds to ICD-9-CM categories 140-208

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9.2 Malignant Neoplasms

• C22 Malignant neoplasm of liver and intraheptic bile ducts • Instructional notes report additional codes to

identify alcohol abuse and dependence

• C46 Kaposi’s sarcoma• When associated with HIV, code B20 prior to C46

• C77-C79 Secondary neoplasms• Sequencing information found in coding guideline

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9.2 Malignant Neoplasms

• C80 category codes for unspecified sites• C80.0 Disseminated malignant neoplasm• C80.1 Cancer without specification of site• C80.2 Malignant neoplasm associated with

transplanted organ

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9.2 Malignant Neoplasms

• C81-C96 Malignant neoplasms of lymphoid, hematopoietic, and related tissues

• Examples:• Hodgkin lymphoma

• Other non-Hodgkin lymphoma

• Multiple myeloma

• Lymphoid leukemia

• Burkitt lymphoma

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9.3 In Situ Neoplasms

• D00-D09 In situ neoplasms (non-invasive)• Examples:

• Bowen’s disease

• Cervical intraepithelial neoplasia

• Ductal carcinoma in situ

• Prostatic intraepithelial neoplasia

• Corresponds to ICD-9-CM categories 230-234

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9.4 Benign Neoplasms

• D10-D36 Benign neoplasms (non-cancerous)• D3a Benign neuroendocrine tumors• Examples of terminology:

• Hemangioma

• Nevus

• Lymphangioma

• Corresponds to ICD-9-CM categories 209-229

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9.5 Neoplasms of Uncertain or Unspecified Behavior

• D37-D49 Neoplasms of Uncertain or Unspecified Behavior

• D37-D44 and D48 are classified by site• Due to specificity of ICD-10-CM, unspecified codes

are rarely used – query provider for clarification• Corresponds to ICD-9-CM categories 235-239

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Summary

• Neoplasms classified by topography

• Behavior identified as malignant, in situ, benign, uncertain or unspecified

• Coding for administration of chemotherapy, immunotherapy, and radiation therapy

• Additional instructions to identify alcohol abuse and dependence, history of tobacco use, tobacco use, and tobacco dependence

• In-situ neoplasms

• Benign neoplasms of endocrine glands

• Uncertain behavior

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