Oncology & Hematology Coding Alert

See if it’s time to brush up your ICD-10-CM guideline knowledge.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below.

Answer 1: The general guidelines accompanying ICD-10-CM Chapter 2 tell you that, “for multiple neoplasms of the same site that are not contiguous such as tumors in different quadrants of the same breast, codes for each site should be assigned.” So, for cancer of both the upper inner and upper outer quadrants of a female left breast, you’ll assign two codes: C50.212 (Malignant neoplasm of upper-inner quadrant of left female breast) and C50.412 (Malignant neoplasm of upper-outer quadrant of left female breast).

However, in scenarios like this, you would do well to query your provider to make sure the neoplasms are not overlapping. That’s because code assignment will change per the same guideline, which tells you “a primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 (‘overlapping lesion’), unless the combination is specifically indexed elsewhere.”

So, if the oncologist documents the patient has overlapping neoplasms of both the upper inner and upper outer quadrants, you’ll just use one code: C50.812 (Malignant neoplasm of overlapping sites of left female breast).

Answer 2: To begin narrowing down the correct code in this situation, you should first go to the ICD-10-CM Alphabetic Index and look up Carcinoma – infiltrating – duct. As the site is specified, the Index tells you go to Neoplasm, malignant, by site, which leads you to C50.0- (Malignant neoplasm of nipple and areola).

This parent code more accurately describes the patient’s condition than codes in the similar-sounding D05.1- (Intraductal carcinoma in situ of breast) subcategory. That’s because intraductal carcinoma in situ, also known as ductal carcinoma in situ (DCIS), is a different form of cancer. While it is also malignant, it does not spread to surrounding tissue as intraductal carcinoma (IDC) does, and so DCIS is coded to a different category.

But there are two more important factors to remember before you land on the correct code.

First, you need to make sure you choose the correct 5th character for C50.0-. The code group is subdivided into male and female codes using 5th character 1 for females and 2 for males. Then, a 6th character specifies right (1) and left (2) breasts. This makes C50.021 (Malignant neoplasm of nipple and areola, right male breast) the correct answer to the question.

Answer 3: Correct coding for this condition depends on your clinical understanding of lipomas. Knowing that these lumps are benign growths of fatty tissue means that you would be correct in bypassing the malignant neoplasm codes immediately. But that doesn’t mean D24.1 (Benign neoplasm of right breast) would be the correct code to use in this situation.

That’s because lipomas, which are not anatomically specific to the breast and can occur almost anywhere in the body, have their own ICD-10-CM category: D17.- (Benign lipomatous neoplasm). These codes are further broken down by anatomical location, making D17.1 (Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk) the correct answer to this question.

Answer 4: “In this case, you’ll assign Z12.31 [Encounter for screening mammogram for malignant neoplasm of breast] and Z80.3 [Family history of malignant neoplasm of breast],” says Jennifer M. Connell, BA, CPPM, CPCO, CDEO, CPMA, CPB, CRC, COC, CPC, CPC-P, CPC-I, CCC, CCVTC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CUC, ROCC, CEMA, CMCS, CMRS, AAPC-Approved Instructor, revenue cycle director of Citizens Medical Professionals in Victoria, Texas.

To understand why, you’ll need to turn to two ICD-10-CM Official Guidelines. The first, I.C.21.c.4, tells you that you can assign a family history code when the patient’s family member(s) had a certain disease, such as breast cancer, which causes the patient to be at greater risk of contracting the disease as well. The section continues to direct you to assign the appropriate personal and family history codes as additional diagnoses following the reason for the encounter, which is the screening in this case.

The second guideline, I.C.21.c.5, indicates that “screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram).” The guideline goes on to instruct that a screening code, such as Z12.31, may be a “first-listed code if the reason for the visit is specifically the screening exam.” In other words, you’ll sequence Z12.31 first as the primary diagnosis, followed by Z80.3.

Remember: You should not use screening codes for patients with signs and symptoms. These encounters should be coded as diagnostic examinations.

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