General Surgery Coding Alert

Question: How should we code malignant breast cancer with findings of metastasis to liver and bone? Should we report only a breast ICD-9 code?

Tennessee Subscriber

Answer:Report the breast cancer first using a primary malignant neoplasm code. You should additionally report a secondary neoplasm code for liver and bone findings.

Breast: Based on the information provided, the correct code for the breast cancer is 174.9 (Malignant neoplasm of breast [female] unspecified site). If the op report identifies the location of the tumor, you should use a more specific diagnosis code for that site, such as 174.1 (Malignant neoplasm of central portion of female breast)

Metastatic sites: You should also code the metastatic cancer noted in the pathology report, presumably based on surgical biopsies to those sites. You mentioned liver, which you should report as 197.7 (Malignant neoplasm of liver secondary). For the bone metastasis, report 198.5 (Secondary malignant neoplasm of bone and bone marrow)