Pathology/Lab Coding Alert

Question: Our pathologist diagnosed malignant neoplasm of the colon and did not indicate the location or origin of the cancer. The resection specimen included a portion of the hepatic flexure and transverse colon. What diagnosis code should we use?

Kentucky Subscriber

Answer: Report 153.8 (Malignant neoplasm of other specified sites of large intestine) for this case. Colon or colorectal cancer can start in the large intestine (colon) or the rectum (end of the colon).

Although the resection includes specific sites that have their own cancer codes: 153.1 (Malignant neoplasm of transverse colon) and 153.0 (Malignant neoplasm of hepatic flexure), you should not select either of those codes.

Here's why: Because the pathology report does not specify the location of the cancer within the specimen, you can't select one of the more specific codes. Instead, you should use 153.8. An ICD-9 text note indicates that the code represents "malignant neoplasm of contiguous or overlapping sites of colon whose point of origin cannot be determined."