Oncology & Hematology Coding Alert

Do not miss payment if your physician does not specify side of the tumor.

In follow up to our quiz in Volume 17, Number 6 “Test Your Understanding for Genitourinary Neoplasm Coding with These Top 10 Questions,” we reveal the answers and explanations. Once you know the patient has a malignant tumor, you’ll choose a code from the C60-C68 categories. 

Learn the Guidelines: All neoplasms, whether functionally active or not, are classified by site (organ, right/left, etc.), behavior (malignant, in situ, benign), location (laterality, quadrant, etc.), and histology (melanoma, neuroendocrine). 

Answer 1: The correct answer is option d, C60.9.

Your physician hasn’t specified the site of malignant neoplasm in the penis. Hence you submit ICD-10-CM code C60.9.

ICD-10-CM offers the following additional site specific codes for malignant neoplasm of the penis:

• C60.0, Malignant neoplasm of prepuce

• C60.1, Malignant neoplasm of glans penis

• C60.2, Malignant neoplasm of body of penis

• C60.8, Malignant neoplasm of overlapping sites of penis

• C60.9, Malignant neoplasm of penis, unspecified

Answer 2: The correct answer is option d, C65.1.

ICD-10-CM has discrete codes for malignant neoplasm in the renal tissue, renal pelvis, and ureter. You pick up the best code depending upon the laterality of the neoplasm, i.e. if the tumor was located in the right or left structure. For malignant neoplasm in the right renal pelvis, you submit ICD-10-CM code C65.1 (Malignant neoplasm of right renal pelvis). For the same in the left renal pelvis, you submit ICD-10-CM code C65.2 (Malignant neoplasm of left renal pelvis).

For malignant neoplasm in the right and left kidneys, you report ICD-10-CM codes C64.1 (Malignant neoplasm of right kidney, except renal pelvis) and C64.2 (Malignant neoplasm of left kidney, except renal pelvis), respectively. 

When your physician does not specify the laterality of the malignant neoplasm in the renal pelvis or renal tissue, you submit codes C65.9 (Malignant neoplasm of unspecified renal pelvis) and C64.9 (Malignant neoplasm of unspecified kidney, except renal pelvis) and, respectively.

Similarly, for malignant neoplasm in the right and left ureter, you report codes C66.1 (Malignant neoplasm of right ureter) and C66.2 (Malignant neoplasm of left ureter), respectively. When your physician does not document the side of the tumor in the ureter, you submit code C66.9 (Malignant neoplasm of unspecified ureter). 

Answer 3: The correct answer is option a, C67.4.

For malignant neoplasm in the bladder, you submit ICD-10-CM code C67.X.

You select the correct code based upon the precise location of the tumor in the bladder. Accordingly, you check for the best code from the following options:

• C67.0, Malignant neoplasm of trigone of bladder

• C67.1, Malignant neoplasm of dome of bladder

• C67.2, Malignant neoplasm of lateral wall of bladder

• C67.3, Malignant neoplasm of anterior wall of bladder

• C67.4, Malignant neoplasm of posterior wall of bladder

• C67.5, Malignant neoplasm of bladder neck

• C67.6, Malignant neoplasm of ureteric orifice

• C67.7, Malignant neoplasm of urachus

When your physician documents the neoplasm in two or more overlapping sites, you submit code C67.8 (Malignant neoplasm of overlapping sites of bladder). When you fail to locate a specific site for the bladder tumor, you submit code C67.9 (Malignant neoplasm of bladder, unspecified).

Tip: For malignant neoplasm of internal urethral orifice, you submit the bladder neck code, i.e. C67.5.

Answer 4: The correct answer is option b, C68.1.

In ICD-10-CM, you will have a specific code for malignant neoplasm of the paraurethral glands, i.e. C68.1 (Malignant neoplasm of paraurethral glands). 

The code series, C68.X applies to malignant neoplasms in the urethra and other urinary organs. For malignant neoplasm in the urethra, you submit code C68.0 (Malignant neoplasm of urethra). For neoplasms in overlapping sites in the urinary organs, you submit code C68.8 (Malignant neoplasm of overlapping sites of urinary organs). You opt for this code when your physician documents primary malignant neoplasm of two or more contiguous sites of urinary organs whose point of origin cannot be determined. However, when your physician does not specify which urinary organ in specific was affected, you submit code C68.9 (Malignant neoplasm of urinary organ, unspecified).

Answer 5: The correct answer is option a, C62.01.

For malignant neoplasm in the testis, you report ICD-10-CM codes from C62.XX series. You should first determine if the documentation states the testis had descended into the scrotum or not. Next you ascertain if the tumor was located in the right or left testis. Accordingly, you select form the following codes: 

• C62.01, Malignant neoplasm of undescended right testis

• C62.02, Malignant neoplasm of undescended left testis

• C62.11, Malignant neoplasm of descended right testis

• C62.12, Malignant neoplasm of descended left testis

When your physician does not specify the right or left side for the malignant neoplasm in the descended or undescended testis, you report code C62.10 (Malignant neoplasm of unspecified descended testis) or C62.00 (Malignant neoplasm of unspecified undescended testis), respectively.

If your physician does not specify if the testis was descended or not, you submit codes C62.91 (Malignant neoplasm of right testis, unspecified whether descended or undescended) and C62.92 (Malignant neoplasm of left testis, unspecified whether descended or undescended) for the right and left testis, respectively. If however, your physician does not specify either the laterality or the descent of the testis, you submit code C62.90 (Malignant neoplasm of unspecified testis, unspecified whether descended or undescended).

Answer 6: The correct answer is option d, C63.00.

You select the best code for malignant neoplasm in the epididymis depending upon whether the tumor was in the right or left epididymis. Since the laterality of the neoplasm is not indicated in the question, you submit ICD-10-CM code C63.00 (Malignant neoplasm of unspecified epididymis). You submit code C63.01 (Malignant neoplasm of right epididymis) when the neoplasm is located it the right testis and code C63.02 (Malignant neoplasm of left epididymis) when it is located in the left testis. 

Answer 7: The correct answer is option b, C63.12.

You select ICD-10-CM code for malignant neoplasm of the spermatic cord depending upon which side was involved. For malignant neoplasm of the left spermatic cord, you report code C63.12 (Malignant neoplasm of left spermatic cord) and for that of the right spermatic cord, you report code C63.11 (Malignant neoplasm of right spermatic cord). If your physician does not specify which side was affected by the tumor, you submit code C63.10 (Malignant neoplasm of unspecified spermatic cord).

Answer 8: The correct answer is option a, C63.7.

For malignant neoplasm of seminal vesicle and tunica vaginalis, you report ICD-10-CM code C63.7 (Malignant neoplasm of other specified male genital organs). “Malignant neoplasm of seminal vesicle” is listed as a note below the code.

Answer 9: The correct answer is option a, C61.

ICD-10-CM offers a specific code for malignant neoplasm of the prostate, C61 (Malignant neoplasm of prostate). 

Note: Code C61 does not apply to malignant neoplasm in the seminal vesicle. For the latter, you submit code C63.7.

Answer 10: The correct answer is option c, C61 for primary and C79.51 for bone metastasis

If you are coding for a tumor that is metastasized to another location, you should use the ICD-10-CM code for the site it is metastatic to. For example, if you are reporting prostate cancer that has metastasized to the bones, you’ll report C79.51 (Secondary malignant neoplasm of bone) for the site of the metastasis in addition to C61 for the primary tumor.