Oncology & Hematology Coding Alert

Question: We are treating a patient for a primary lung neoplasm of the right upper lobe. The patient had a right lung transplant several years ago. When the patient presents for chemotherapy, which diagnosis code(s) should we assign?

Georgia Subscriber

Answer: Your first-listed code should be V58.11 (Encounter for antineoplastic chemotherapy). ICD-9 official guidelines indicate this is the appropriate first-listed code when the patient presents solely for chemotherapy (www.cdc.gov/nchs/data/icd9/icdguide10.pdf).

Next you need to deal with the fact that the neoplasm is in a transplanted organ. To indicate the transplant status, you should report 199.2 (Malignant neoplasm associated with transplanted organ). This code includes two important instructions which will require you to choose additional codes:

1. "Code first complication of transplanted organ (996.80-996.89)": For this case, report 996.84 (Complications of transplanted lung).

2. "Use additional code for specific malignancy site": For this case, report 162.3 (Malignant neoplasm of upper lobe bronchus or lung).

Result: Your first-listed code should be V58.11, and then you should report 996.84, 162.3, and 199.2 as secondary codes.

Helpful: Code 199.2 applies to a variety of transplant-related malignancies. The possibilities include the patient having a previous cancer recur and spread to the transplanted organ, the transplanted organ having undetected malignant cells before transfer, or the patient developing cancer while his immune system is weakened from immunosuppressant therapy used to prevent transplant rejection, according to ICD-9 Coding Clinic (2008, vol. 25, no. 4).