Oncology & Hematology Coding Alert

Question: Our patient has been diagnosed with soft tissue Ewing’s sarcoma of the left leg with no bone involvement. When I reference “Sarcoma, Ewing’s” in the alphabetic index, I’m directed to “see Neoplasm, bone, malignant” but our patient’s cancer is not of the bone. How should I code for him?

Vermont Subscriber

Answer: You’re right that the entry next to “Sarcoma, Ewing’s” in the alphabetic index directs you to codes for neoplasms of the bone, but there’s another important detail when searching for your code.

If you look at the term “Sarcoma” in the alphabetic index, at the very top of the list of corresponding diagnosis codes you’re advised to “see also Neoplasm, connective tissue, malignant.” It’s under these search terms that you’ll find the correct code for your patient.

When you turn to the Table of Neoplasms and reference “Neoplasm, Connective Tissue, Malignant, Leg,” you’re directed to 171.3 (Malignant neoplasm of connective and other soft tissue; lower limb, including hip).

“Although Ewing’s sarcoma most commonly occurs in bone, it can also develop in soft tissue (called extra-osseous),” states AHA Coding Clinic for ICD-9-CM (Third Quarter, 2012).

ICD-10-CM: To code the same diagnosis under ICD-10-CM, you’ll need to know the leg involved to choose the most specific code:

·         C49.20, Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip

·         C49.21, Malignant neoplasm of connective and soft tissue of right lower limb, including hip

·         C49.22, Malignant neoplasm of connective and soft tissue of left lower limb, including hip.