Pathology/Lab Coding Alert

Make sure you’re ready to use the tools for ICD-10 neoplasm coding that you read about in “4 Steps Focus Neoplasm Coding.”

Heed Different Sites

Study the following examples and solutions to hone your skills:

Scenario: 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.

Solution: Code this patient’s diagnoses as follows, says Judy Adams, RN, BSN, HCS-D, HCS-O, with a consulting firm in Asheville, N.C.:

• 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.

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

The neoplasm of the primary site is unresolved in this patient’s situation, so you’ll list this code first, Adams says. Next, list the secondary sites. These areas aren’t contiguous, so you’ll list a code for each site.

Tricky: Codes for neuroendocrine tumors can be difficult to find when verifying the code because the code looks different than the other neoplasm codes, says Joan Usher, BS, RHIA, COS-C, ACE, AHIMA-Approved ICD-10-CM Trainer with JLU Health Record Systems in Pembroke, Mass.

For example, C7A.090 (Malignant carcinoid tumor of bronchus and lung) has an “A” as its third character, rather than a number like the other neoplasm codes. If you’re 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.” And you’ll see that the C7A codes follow C73-C75.

Another Example: How would you code for the diagnosis “benign carcinoid of the jejunum?”

Look up the term “carcinoid” in the Alphabetical Index, since you know the morphology of this patient’s neoplasm, Adams says. You’ll be directed to “see Tumor, carcinoid.” When you look under “Tumor, carcinoid,” you’ll find that the codes are divided up between benign and malignant, and categorized by site.

Look under “Tumor, carcinoid, benign, jejunum,” and you’ll be directed to code D3A.011. Check this code in the Tabular List and you’ll see notes directing you to “Code also any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)” and “Use additional codes to identify any associated endocrine syndrome such as: Carcinoid syndrome (E34.0).” Your diagnosis code for this patient is D3A.011 (Benign carcinoid tumor of the jejunum).