Oncology & Hematology Coding Alert

Question: How do you code recurrence of a tumor such as breast or lung? Is it a primary site?

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Answer: For a recurrent tumor, choose the code based on whether the neoplasm is primary or metastatic. Watch the documentation for whether the recurrence is local or distant to decide which code is appropriate.

Local: Locally recurrent means the tumor recurs at the original or primary tumor location. You should code this locally recurrent (or recurrent primary) tumor as a primary tumor of the stated site, according to AHA Coding Clinic for ICD-9-CM (May-June, 1985). For example, choose a primary breast neoplasm code such as 174.x (Malignant neoplasm of female breast ...).

Distant: Distant recurrence comes back as metastases. If the cancer recurs as metastases, assign a metastatic code for the specified site, Coding Clinic says. For example, if the pathology report indicates metastatic recurrent carcinoma of lung, you would consider 197.0 (Secondary malignant neoplasm or respiratory and digestive systems; lung).

Caution: For blood cancers, such as leukemia, pay attention to your fifth digit options when documentation specifically indicates relapse, meaning the patient has recurrent disease following previous treatment. For example, for acute lymphoid leukemia in relapse, you should report 204.02 (Lymphoid leukemia; acute; in relapse).