Gastroenterology Coding Alert

Question: At a coding conference I attended recently, there was a debate in one of the seminars about the definitions of various types of neoplasms (carcinoma in situ, malignant primary and malignant secondary). At the end of the seminar, there still was no agreement as to what these terms meant. What do they mean and how should that effect my ICD-9 coding?


Florida Subscriber

Answer: In a brief discussion of ICD-9 coding, the Health Care Financing Administration (HCFA) defines carcinoma in situ as cancerous neoplasms that are confined or noninvasive. A malignant primary is the original site of a neoplasm that has become invasive; HCFA also uses the term metastatic from to describe a site that is interpreted as the primary one. A malignant secondary is a secondary cancerous site; HCFA uses the term metastatic to to describe a site that is interpreted as secondary.

Only a pathologist can determine with certainty whether a biopsied mass is malignant or benign, carcinoma in situ or malignant primary, says Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates, a 21-physician practice. In her office, endoscopic biopsies are not billed until 48 hours after the procedure, when the pathology report comes back.

In gastroenterology, its not that important to differentiate between primary and secondary sites of a cancer. Unless the gastroenterologist knows of a pre-existing condition, then a neoplasm is always considered to be primary, she explains. Its too difficult to figure out where the original site of the cancer was.

What is more important, Parks thinks, is to code correctly for benign and malignant neoplasms. Shes heard horror stories of when neoplasms were coded as malignant when they were benign, and then the patients were unable to get life insurance or a new health insurance policy because that incorrect information was on their medical record.

On the other hand, incorrectly coding a neoplasm benign when its malignant can affect reimbursement for future procedures. Insurance companies wont usually pay for a follow-up colonoscopy six months later for a diagnosis of benign neoplasm, she notes.