Oncology & Hematology Coding Alert

Question: Our physician diagnosed a malignant main bronchial neoplasm for a patient who has been a chronic smoker. How should we report this?

California Subscriber

Answer: First, you don’t say whether your provider specified laterality for the malignant neoplasm of the bronchus. If the provider did specify laterality, you can use a specific code such as C34.01 (Malignant neoplasm of right main bronchus), C34.02 (Malignant neoplasm of left main bronchus). You can also use both codes if the provider specifies the cancer is bilateral. And if your provider does not specify laterality, you will have to use C34.00 (Malignant neoplasm of unspecified main bronchus).

No matter which code you eventually report, you will also have to use a code to document the patient’s chronic smoking as the C34.- codes come with a “Use additional code” instruction to report the following as supported by the documentation:

• Exposure to environmental tobacco smoke (Z77.22)
• Exposure to tobacco smoke in the perinatal period (P96.81)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Nicotine dependence (F17.200 - F17.299)

As you will not find an ICD-10-CM code for chronic smoking, you will have to use a code such as Z72.0 (Tobacco use) or Z87.891 (Personal history of nicotine dependence) depending on the explanation of the patient’s tobacco use and timing. But this time, you must defer to your provider’s documentation and not notations in the patient’s record made by anyone else when selecting the most appropriate code. If more information is needed to determine the correct code, query the physician and ask that the documentation be clarified using your internal late entry documentation/addendum policy to have the information added to the record.