Oncology & Hematology Coding Alert

Question: What ICD-9-CM code should we use to report prophylactic brain radiation in a patient who has a primary diagnosed in the lung?.

Ohio Subscriber

Answer: You have multiple codes to consider for this encounter.

To report the primary lung cancer, you choose from codes depending upon where the primary source of the neoplasm was found in the lung.

• 162.3 (Malignant neoplasm of upper lobe bronchus or lung),
  
• 162.4 (Malignant neoplasm of middle lobe bronchus or lung),
  
• 162.5 (Malignant neoplasm of lower lobe bronchus or lung),
  
• 162.8 (Malignant neoplasm of other parts of bronchus or lung), or
  
• 162.9 (Malignant neoplasm of bronchus and lung unspecified).
  

You mention the service is prophylactic, therefore if patient does not have a documented metastatic focus in the brain, you only report the appropriate lung cancer code from 162.3-162.9 and not a brain neoplasm code.

Report code 198.3 (Secondary malignant neoplasm of brain and spinal cord) only for a known secondary brain cancer. Remember that according to ICD-9-CM official 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” (www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf).

Since there is no confirmed secondary site and the treatment is administered prophylactically prevent a potential spread of the neoplastic disease, you would report code V07.8 (Other specified prophylactic or treatment measure).

Remember, ICD-9-CM guidelines also require the use of V58.0 (Radiotherapy) as the primary diagnosis on the encounter for radiotherapy. The ICD-9-CM guidelines state, “If a patient admission/encounter is solely for the administration of … radiation therapy assign code V58.0, Encounter for radiation therapy.” Lastly, the ICD-9-CM code for the primary lung neoplasm would be listed as a secondary/contributing diagnosis.

Keep in mind that payer’s may not cover prophylactic therapy.