Gastroenterology Coding Alert

Question: Which code should be used for cancer in a polyp? When is this considered cancer in the intestine? Once the polyp is removed, does the patient now have a history of colon cancer?

Florida Subscriber

Answer: Cancer of the colon usually begins as a polyp, which is a benign growth in the lining of the large intestine. There are two types of polyps found here: hyperplastic and adenomas. Hyperplastic polyps are small, completely benign polyps that do not carry a risk of developing into cancer. On the other hand, adenomas are benign polyps that are considered precursors of colon cancer. Occasionally an adenomatous polyp will contain an area of cancer reported by the pathologist as carcinoma in situ on the final laboratory report.

If the doctor removed a polyp in the colon that is believed to be benign at the time of removal, then it is acceptable to code either 211.3 (Benign neoplasm of colon) or a code from the 153 series (Malignant neoplasm of colon). If you use the 153 series, you should code to the greatest degree of specificity: 153.0 (Hepatic flexure), 153.1 (Transverse colon), 153.2 (Descending colon), 153.3 (Sigmoid colon), 153.4 (Cecum), 153.5 (Appendix), 153.6 (Ascending colon), 153.7 (Splenic flexure), or 153.8 (Other specified site). Most practices do not wait for final pathology results to complete a claim.

Subsequently, the patient would have a history of colon cancer, and you should use the diagnosis code for history of colon cancer, V10.05 (Personal history of malignant neoplasm; colon).