Home Health ICD-9/ICD-10 Alert

Question: Our new patient has lung cancer. The physician document states that he has a primary neoplasm of the right lower lobe with metastasis to the left lung. Do both the left and right lungs fall under the primary code? Or should we report both a primary code and a secondary code?

Texas Subscriber

Answer: When the physician documents a primary right lower lobe neoplasm with metastasis to the left lung, you should report:

• 162.5 -- Malignant neoplasm of lower lobe bronchus or lung for the right lobe and
• 197.0 -- Secondary malignant neoplasm of lung for the left lung.

Support: ICD-9 Coding Clinic (2010, vol. 27, no. 3) addressed a similar question in which the patient had been diagnosed with cancer of the left lower lobe and metastasis to the right lung, peritoneum, and liver. Coding Clinic stated proper coding would include 162.5 (lung primary), 197.0 (lung secondary), 197.6 (Secondary malignant neoplasm of retroperitoneum and peritoneum), and 197.7 (Malignant neoplasm of liver secondary).

Caution: Don't assume that the presence of a second neoplasm in the same organ system as a primary neoplasm means that you have both primary and secondary neoplasms. A patient may have two primary neoplasms in the same organ system. Always let the documentation guide your choice.

ICD-10-CM: When ICD-10-CM becomes effective, 162.5 will be replaced by C34.3- (Malignant neoplasm of lower lobe ...) and 197.0 will translate to C78.0- (Secondary malignant neoplasm of ... lung). Your final code choice will depend on whether the lung is documented as left, right, or unspecified.