Pathology/Lab Coding Alert

Look for clues in the pathology report.

You’ve arrived — after years of preparation, you’re finally using ICD-10 to report diagnoses that your pathologist documents in the written report.

So how are you doing with coding neoplasms? Let us help you zero in on what you need to know when you’re faced with the common experience of reporting a cancer diagnosis from a pathology report.

Step 1: Start with Histologic Term

Just as with ICD-9, if the pathology report documents a histological term for the neoplasm, such as “adenocarcinoma” or “myolipoma,” you should first look it up in the Alphabetical Index. That’s where you can find the code reference and any other instructions about the condition that you need to know.

Histologic terms in the Alphabetical Index typically include direction about how to categorize the neoplasm behavior. You’ll need that information when you take Step 2 — which is turning to the Neoplasm Table — to help you zero in on the right code.

Don’t miss: There are certain histological terms that list the correct codes in the Alphabetical Index and do not refer to the Neoplasm Table. Examples include melanoma and Merkel cell carcinoma.

That’s why you should “always check the Alphabetical Index first,” says Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA approved ICD-10-CM trainer/ambassador of Selman-Holman & Associates, LLC, CoDR — Coding Done Right and Code Pro University in Denton, Texas.

Step 2: Turn to the Neoplasm Table

After checking the Alphabetical Index, your next stop when using ICD-10 to code for a neoplasm is the Neoplasm Table. You’ll find the table just after the end of the Alphabetical Index in your coding manual, rather than under “N” in the Alphabetical Index as it was in ICD-10, says Joan Usher, BS, RHIA, COS-C, ACE, AHIMA-Approved ICD-10-CM Trainer with JLU Health Record Systems in Pembroke, Mass.

To locate the appropriate code in the Neoplasm Table, you’ll need to know the affected anatomical site (such as skin, breast, liver, or other site) and the neoplasm “behavior.” The primary classifications of behavior are “malignant,” which means that the cancer has the capacity to spread to distant sites, “benign,” which means that the cancer type does not spread, and “uncertain behavior,” which means that the cancer is not clearly a type that is benign or malignant. The neoplasm table also lists codes for “unspecified behavior,” which you should use if the pathology report does not provide a clear indication of the cancer specimen behavior.

There’s more to malignant: The neoplasm table further subdivides malignant cancers based on certain characteristics of the specific tumor specimen. For instance, the table lists “Carcinoma in situ” (Ca in situ), which means that the cancer is currently contained at the site, even though it is a malignant type that has the potential to spread. Other malignant cancer designations in the Neoplasm Table include “primary,” which means that the cancer being diagnosed is at its site of origin, or “secondary,” which means that the cancer being diagnosed has spread to the current site from a distant, primary site.

Step 3: Verify Using Tabular List

Once you locate your pathologist’s description in the Alphabetical Index and the Neoplasm Table, you should have a code number. But you shouldn’t just assign that code and stop there. Never finalize a diagnosis without verifying the code in the Tabular List.

Checking the code against the Tabular List provides guidance on laterality, site location, gender, whether you need to use an additional code to report your patient’s condition, as well as any excludes notes, Usher says.

Step 4: Follow Sequencing and Site Guidance

If you’re coding a malignant cancer, you might be dealing with a metastatic condition where the neoplasm has spread from one site to another. When coding a neoplasm that has metastasized to a secondary site, you’ll usually code the primary site before the metastasis.

Exception: If the secondary site is the focus of care, or if the primary site has been resolved, you can code for the metastasis first.

Site rules: When coding for a malignant neoplasm that overlaps two or more contiguous sites, you’ll report the “multiple sites” code ending with character “8” in most cases, such as C00.8 (Malignant neoplasm of overlapping sites of lip). But when a patient has multiple neoplasms of the same site that aren’t next to each other, such as tumors in different quadrants of the same breast, you’ll assign codes for each affected site.