Pulmonology Coding Alert

Point of origin is the primary criterion to decide the correct code.

Changing lifestyle and environmental factors have led to greater incidences of cancer encounters in your pulmonology practice and you may be struggling to keep track of the various terminologies needed to code the same. Let us simplify the complexities of a lung cancer diagnosis, short for malignant neoplasm of the lung and bronchus, and help you understand how its reporting will change after the Oct. 1, 2015 ICD-10 transition. 

Lock on the Cancer Location for Accurate Reporting

Regardless of the cell type, the ICD-9-CM code for primary malignant neoplasm of the lung is 162.x (Malignant neoplasm of trachea bronchus and lung), with the fourth-digit subcategory identifying the specified site of the cancer. Based on your physician’s confirmation you have a choice from 0 to 9 as the fourth digit code the exact site of the neoplasm:

• 0 -- Trachea;
  
• 2 -- Main bronchus;
  
• 3 -- Upper lobe, bronchus or lung;
  
• 4 -- Middle lobe, bronchus or lung;
  
• 5 -- Lower lobe, bronchus or lung;
  
• 8 -- Other parts of bronchus or lung (includes malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined); and
  
• 9 -- Bronchus and lung, unspecified.
  

Note: The above given codes are only applicable for small and non-small cell cancers. ICD-9 has separately mapped carcinoid tumors to 209.21 (Malignant carcinoid tumor of bronchus and lung) and 209.61 (Benign carcinoid tumor of the bronchus and lung).

Under the ICD-10-CM system, you will have to look up sections C33 (Malignant neoplasm of trachea) and C34 (Malignant neoplasm of bronchus and lung) for reporting the neoplasms. Code 162.0 directly crosswalks to C33.

Section C34 further expands into a fourth digit 0-9 depending on the location of the neoplasm. The crosswalk from ICD-9 is fairly straightforward with 162.2 mapped to C34.0 (Malignant neoplasm of main bronchus); 162.3 crossmatches with C34.1 (Malignant neoplasm of upper lobe, bronchus or lung); 162.4 matches with C34.2 (Malignant neoplasm of middle lobe, bronchus or lung); 162.5 walks to C34.3 (Malignant neoplasm of lower lobe, bronchus or lung); 162.8 is mapped to C34.8 (Malignant neoplasm of overlapping sites of bronchus and lung); and 162.9 converts to C34.9 (Malignant neoplasm of unspecified part of bronchus or lung).

What’s new: Here’s where the similarities between ICD-9 and ICD-10 end, because except for C34.2, the other ICD-10 codes have a further fifth digit expansion (0-2) that will help you pinpoint exactly which part of the lung the cancer is situated: 

0 -- unspecified bronchus or lung
1 -- right bronchus or lung
2 -- left bronchus or lung

So, for example, if you want to report a diagnosed cancer in the right lower lobe, you will report C34.31 and if you have a diagnosis of a cancer of the left main bronchus, you will report C34.02.

Focus on These Coding Possibilities

A probable cancer patient may present with one or many of the following symptoms:

• A cough that does not go away or gets worse (786.2)
• Coughing up blood or rust-colored sputum (spit or phlegm) or Hemoptysis (786.39)
• Chest pain that is often worse with deep breathing, coughing, or laughing (786.52)
• Hoarseness (784.42)
• Weight loss and loss of appetite (783.21)

Look for diagnostic tests advised by your physician such as a chest x-ray, CT scan, and sputum culture. The physician will also order a transbronchial lung biopsy (31628, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe). The physician may also advise a thoracentesis (32554, Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidanceor 32555, Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance) that helps identify cancerous cells in the fluid of the chest cavity.

Best practices: You should read the operative report completely to determine the procedure performed prior to code assignment. After confirming a malignant growth, you will report the exact diagnosis code, depending upon the location of origin of the cancer as described earlier. Lung cancer treatment depends on the size, location, stage, and type of cancer as well as an individual’s overall health. The physician may suggest surgery, radiation therapy, and chemotherapy alone or in various combinations to address the cancer. The physician may advise surgery as the option of choice if the cancer is confined to a limited area.