Home Health ICD-9/ICD-10 Alert

Question: The coding quiz in your January 2010 issue included the following question: Which of the following is the ICD-9 2010 diagnosis code you'll report for a patient with an unspecified neoplasm?

You said the answer was C, 239.89 (Neoplasms of unspecified nature; other specified sites) and went on to explain that as of Oct. 1, 2009, 239.8 (Neoplasms of unspecified nature; other specified sites) is an invalid code because this category now requires five digits. However, I believe the correct answer should be 199.1 (Malignant neoplasm without specification of site).

Answer: Both 199.1 and 239.89 describe situations in which something about the cancer is unspecified. Listing 199.1 for your patient's neoplasm indicates that the site of the cancer is unspecified. Reporting 239.89 indicates that the morphology and behavior of the neoplasm is unspecified. In most cases, when it's appropriate to report a 239.x code, the site of the neoplasm is specified. For example, when the patient has a tumor but there has been no biopsy so whether the tumor is benign or malignant is not known. In this case, the site of the neoplasm is known, but not the nature. The exception is 239.9 (Neoplasms of unspecified nature; site unspecified). In our coding quiz, the question referred to an "unspecified neoplasm" not a neoplasm with an unspecified site, so 239.89 was the right code.