# Neoplasm coding HELP...PLEASE!!!



## fritzta (Sep 13, 2009)

"Adenocarcinoma metastatic to lung and rib (bone), unknown primary"

I was coding:

196.1 (pulmonary)
199.1 (site unknown)

Does that look right?


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## rad1965 (Sep 13, 2009)

look at 162.8


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## whaleheadking (Sep 14, 2009)

197.0 secondary malignant neoplasm of lung
198.5 secondary malingnant neoplasm of bone

Since you don't know the primary, there's no need to code it.


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## mitchellde (Sep 20, 2009)

You must code the primary site with the secondary sites and if documented as unknown, then it is 199.1, I agree with the 197.0 and the 198.5 also.


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## LScottCPC (Sep 21, 2009)

I agree with Debra Mitchell.  199.1, 196.1, 198.5.


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## FTessaBartels (Sep 22, 2009)

*Sequencing*

Per ICD9 guidelines:  If treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis, even though the primary malignancy is still present. 

In this case you don't even know the primary site, so I'd code 199.1 last. 

F Tessa Bartels, CPC, CEMC


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## sammie06 (Feb 8, 2010)

If they had code 162.9 malignant neoplasm of bronchus and lung but no longer have can they just use code 198.5 secondary malignant neoplasm of bone and bone marrow or would they use both with code 198.5 being the primary


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## mitchellde (Feb 9, 2010)

If the metastic site is "cured" then it is no longer coded.  Remember the metastatic site is just the primary neoplasm in a different organ.  This is why you always code the primary as either stil present , hx of or unknown.  So if the mets to the lung is no longer present then code only the bone mets 198.5 with in this scenario 199.1 for the unknown primary.  You sequence first that which is being treated on this encounter.


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## whaleheadking (Feb 10, 2010)

I'm still not convinced that coding the primary is necessary given the lack of information.  Adding 199.1 is saying that the pt has an active primary tumor as opposed to a history of cured cancer somewhere (V10.whatever).  Lacking the documentation to say that the pt has active primary, I'm hesitant to apply it.    

Mind you, I am approaching this from the Pathology Dept. where we usually have very little clinical information to work with.


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