ICD 10 Coding Alert

Avoid potential denials by brushing up on the whys behind your neoplasm coding choices.

The ICD-10-CM manual addresses neoplasms in Chapters 2, 3, and 4. If you’re not already following the guidance for reporting neoplasms — diseases of the blood and blood-forming organs, as well as endocrine and metabolic diseases — the oversight could cost you in denials.

Keep these five tips handy when reporting neoplasms, and you’ll be on your way to successful claims.

Tip 1: Know Why Primary Site and Behavior Matter

ICD-10-CM Chapter 2, Neoplasms, contains numerous broad groups of neoplasms, whether functionally active or not. Check the medical chart documentation to help you determine the primary site and nature of the neoplasm. When functionally active, you can use additional codes from Chapter 4 – Endocrine, Nutritional and Metabolic Diseases (E00 – E89), to identify the activity associated with the neoplasm.

The morphology contained in Chapter 2 classifies neoplasms primarily by site, with groupings for behavior (malignant, in situ, benign, etc.).

Heads up: Two key points to remember are:

1. You should classify primary malignant neoplasms overlapping site boundaries as overlapping lesions, and
2. You should code malignant neoplasm of ectopic tissue to the site/location of the tissue.

Tip 2: Look Out for These Related Issues

First, check out how to report dehydration in patients with carcinoma-related concerns.

Official Coding Guideline I.C.2.c.3 mandates if a malignancy results in dehydration, and the dehydration is being managed in your oncology practice, you should consider the admission/encounter as management of dehydration followed by the codes for the malignancy diagnosis.

What to document: Oncologists need to document dehydration when applicable to the treatment and condition and avoid the less specific codes involving NEC (Not elsewhere classified) descriptors. When sequencing dehydration resulting from malignancy, the dehydration needs to be sequenced first, followed by the code(s) for the malignancy. A note located under code E86.0 (Dehydration) indicates additional code(s) for any associated disorders of electrolyte and acid-base balance (E87.0-) that are due to the dehydration must be coded as secondary diagnosis code(s).

Next, check out how to code neoplastic related pain.

If an admission/encounter is for a neoplasm-related pain, this circumstance should be specified by the oncologist as well. Similar to the above concept, Official Coding Guideline I.C.6.3.5 indicates code G89.3 (Neoplasm related pain (acute) (chronic)) should be assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. You will assign this code regardless of whether the pain is acute or chronic. The code may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/ pain management. The underlying neoplasm should be reported as an additional diagnosis when the sole purpose of the encounter is for pain control/pain management.

Tip 3: Be Aware of Neoplasms of Digestive Organs

You will find malignant neoplasms of the liver (C22) included in the malignant neoplasm of digestive organs section (C15-C26).

Keep in mind: The diagnosis code for a liver neoplasm excludes:

• malignant neoplasm of biliary tract;
• secondary malignant neoplasm of liver and intrahepatic bile duct.

Additional information: As can be common to oncology, many category codes will require the assignment of secondary diagnosis codes to completely describe a patient’s condition. The “code also” note located under category code C22 specifies a code from F10.- must be assigned. The “code also” note under category code C22 mandates a code from B16.-, B18.0-B18.1 should also be assigned to describe any associated hepatitis B; and/or a code from B17.1-, B18.2 to describe any associated hepatitis C infection.

Remember, liver includes liver cell carcinoma, intrahepatic bile duct carcinoma and hepatoblastoma, angiosarcoma of liver.

Be Aware: Many of the diagnoses from categories C15-C26 require an additional 4th digit in order for the code to be valid.

Tip 4: Use More Specific Codes for Common ED Hemorrhage Presentations