Oncology & Hematology Coding Alert

Question: Our oncologist has documented a primary lung cancer along with lung metastasis. Can we code for the lung metastasis along with the primary cancer in the lung?.

Ohio Subscriber

Answer: When your oncologist documents a primary neoplasm in the lung, you report 162.3 (Malignant neoplasm of upper lobe bronchus or lung), 162.4 (Malignant neoplasm of middle lobe bronchus or lung), or 162.5 (Malignant neoplasm of lower lobe bronchus or lung) depending upon the location of the primary lesion. For the secondary lesion, you report code 197.0 (Secondary malignant neoplasm of lung).

Caution: Check the documentation again to confirm that the second lung lesion is indeed a secondary/metastasis neoplasm in the lung. There can be two or more primary lung neoplasm foci. The same applies to organ systems other than the lungs.

Tip: You report an encounter code if your oncologist is seeing the patient for administration of radiotherapy, immunotherapy, or chemotherapy. If the patient solely presents for treatment, you report code V58.0 (Encounter for radiotherapy), V58.11 (Encounter for antineoplastic chemotherapy), or V58.12 (Encounter for immunotherapy for neoplastic condition) depending upon the type of treatment. Similarly, if your oncologist is only providing palliative treatment, you report V66.7 (Encounter for palliative care). And you may report the symptom the palliative treatment is intended to ease, as well, such as 786.05 (Shortness of breath).