OASIS Alert

There's more to tumors than malignant and benign.

In choosing diagnosis coding for M0230 and M0240, you need to understand the terminology underlying the codes you choose. If the physician doesn't specify, the medical record may provide the clues.

When you look at the neoplasm table in your ICD-9 coding manual, you find two main categories of neoplasm: malignant and benign. But within each of these are various subcategories. There are three subcategories for malignant tumors:

1. Primary. A primary malignancy is one arising from the cells found where the surgeon biopsied the neoplasm.

Example: If the female patient has a breast lump in the lower-inner quadrant that is malignant and comprised of cancer cells from the area of excision, as opposed to cancer cells that originated elsewhere and spread to the breast, code for a primary malignancy (174.3, Malignant neoplasm of female breast: lower-inner quadrant).

2. Secondary. Use secondary codes when the neoplasm is the result of metastasis and forms a new focus of malignancy elsewhere or when the primary tumor has invaded adjacent structures.

Example: If the surgeon removed a lump from the chest wall beneath a previous mastectomy and the pathology shows that lump is a secondary malignancy with the breast as the origin, you would report a secondary neoplasm code (198.89, Secondary malignant neoplasm of other specified sites, other).

3. In situ. In situ describes malignancies confined to the origin site without invasion of neighboring tissues, although they can grow large enough to cause major problems.

Example: Neoplasm of the breast (223.0, Carcinoma in situ of breast), bladder (233.7, Carcinoma in situ of bladder) and cervix (233.1, Carcinoma in situ of cervix uteri) can be in situ, but there is no guarantee that removing the mass will totally eradicate the cancer.

Note: For detailed home health coding information, order Eli's Home Health ICD-9 Alert at www.elihealthcare.com or call 1-800-874-9180.