Oncology & Hematology Coding Alert

Question: The pathologist examines a biopsy from the right lower lobe of the lung, a bone biopsy from a surrounding rib, and intrathoracic lymph nodes. The pathology report identifies unresolved non-small cell carcinoma of the right lower lobe of the lung with metastasis to the intrathoracic lymph nodes and right rib. What diagnosis codes should I use?

California Subscriber

Answer: Code this patient’s diagnoses as follows:

• C34.31 (Malignant neoplasm of lower lobe, right bronchus or lung)
• C77.1 (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes)
• C79.51 (Secondary malignant neoplasm of bone)

To begin coding for this patient, start with the Alphabetical Index, because you know the histological term — “Carcinoma.” The Alphabetical Index will lead you to the Neoplasm Table; by site, malignant.

Since the neoplasm of the primary site is unresolved in this patient’s situation, list this code first. Next, move on to identify and assign a code for the secondary sites. These areas are not considered contiguous, so you’ll list a separate code for each site.

Tricky: Codes for neuroendocrine tumors can be difficult to find when verifying the code because the code looks different from the other neoplasm codes.

For example, C7A.090 (Malignant carcinoid tumor of the bronchus and lung) has an “A” as its third character, rather than a number like the other neoplasm codes. If you are having difficulty finding a code in the Tabular List, go to the beginning of the chapter and review the list of broad groups of neoplasms, Usher suggests. “This defines the different grouping of the codes within the chapter.” There, you will see the C7A codes follow C73-C75.