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Oncology & Hematology Coding Alert

READER QUESTIONS:

Set Treated Secondary Neoplasm in Primary Spot

Published on Fri Apr 14, 2006

Question: If colon cancer metastasizes to the brain and the patient presents for treatment of the brain cancer, should I report the colon cancer as the primary diagnosis?


Louisiana Subscriber
Answer: No--you should report the cancer being treated as the primary diagnosis, according to the official ICD-9-CM coding guidelines: -When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present- (see www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf).

Example: A patient's colon cancer (154.0, Malignant neoplasm of rectum, rectosigmoid junction, and anus; rectosigmoid junction) metastasizes to the occipital lobe of his brain (198.3, Secondary malignant neoplasm of other specified sites; brain and spinal column) and he presents for treatment of the brain cancer. Report 198.3 before 154.0.
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