Look to Table of Neoplasm Neuroblastoma Coding
Question: How do I find the correct code for a neuroblastoma diagnosis? The documentation says the malignancy is in the adrenal gland. The ICD-10-CM book has three entries for neuroblastoma in the Alphabetic Index: olfactory, specified by site, and unspecified. If the neuroblastoma site is specified but not in the nasal cavity, how do I find the correct code? Florida Subscriber Answer: ICD-10-CM Chapter 2: Neoplasms (C00-D49) General Guidelines tell coders to reference the Neoplasm Table in the Alphabetic Index first, unless the histological term is documented: “… if the histological term is documented, that term should be referenced first, rather than going immediately to the Neoplasm Table, in order to determine which column in the Neoplasm Table is appropriate.” There isn’t a specific blastoma section within the neoplasm codes, so you need to rely on the anatomical location of the blastoma to find the correct code. For a neuroblastoma that isn’t olfactory but is specified, you’ll need to go beyond the neuroblastoma section and look to Neoplasm, malignant, by site. If you look at the Table of Neoplasms in ICD-10-CM, you can cross-reference Malignant Primary column and Adrenal Gland row, which will point you to C74.9- (Malignant neoplasm of unspecified part of adrenal gland); though you’ll need a 5th character, too. If the documentation specifies which part of which adrenal gland the malignancy affects, your options are: Remember to check your code selection in the Tabular List as well, to double-check that a more specific code doesn’t exist. Also, you don’t mention any secondary sites or treatment options, nor any complications involved in this specific encounter; if this is accurate, then this primary malignancy, if supported by the documentation, may be designated as the principal/first-listed diagnosis, according to ICD-10-CM Chapter 2 Coding Guidelines. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
