# cancer coding



## HKOFOID (Apr 10, 2009)

The diagnosis states, 'T-spine metastases with severe canal stenosis: Likely a metastatic breast cancer.' I am confused because I am new to coding and have not ever coded a secondary cancer, which it seems to me that the doctor is stating the thoracic spine is secondary, but then the breast cancer is secondary. Am I reading this correctly? I am super confused.


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## pareli (Apr 10, 2009)

I feel your pain!  Metastatic Breast CA means it's Metastatic from the breast.


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## faym7 (Apr 10, 2009)

I would determine from that the brest is primary the spine is secondary


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## mitchellde (Apr 10, 2009)

I was an Oncology coder for about 8 years, so here is how I would interpret that.  He is saying the spine is the metastatic site (198.5) and he is supposing from the primary site of the breast but is unsure.  Therefor code as seconday spine with unknown primary (199.1).  Remember to always indicate a primary site with the secondary, even if the primary is unknown.


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## pharmon (Apr 12, 2009)

Michelle I sent you a private.  I had a cancer question myself.


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## HKOFOID (Apr 13, 2009)

Thank you!


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## DanaCathleen (Aug 12, 2016)

*Cancer coding*

I have a cancer coding question.  the record is past 30 days so I can't query the Dr.    

The chief complaint being severe back pain, constipation, nausea  and vomiting of a 68 yr old man with known metastatic cancer. The assessment listed "prostate cancer metastatic to multiple sites" hepatic and biliary cancer and metastatic pancreatic cancer.  Metastatic Adenocarcinoma to liver of unknown primary site.  

Member was given pain, constipation and nausea medications, no treatment to the cancer only the short descriptive/diagnostic statements from the HP and under the impression/assessment was - continue to monitor and contact the oncologist for the neoplasms.  Member is on chemo but the nausea/vomiting or constipation was not linked to the chemo or the pain meds the patient was taking.    

I said to code the neoplasm related pain G89.3, C25.9 (pancreas part unspec primary with liver and biliary 2nd) C78.7,  prostate cancer C61. constipation- K59.00 then the nausea and vomiting R11.2  lastly the chemo status code Z78.81X (can't remember name of chemo drug). No mention of drinking or smoking history.  
I need help on this.   thanks so much!


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