Pulmonology Coding Alert

Question: How should I choose from among the various categories (primary malignant, secondary malignant, etc.) in the neoplasm table? What's the difference between "uncertain" and "unspecified"?

California Subscriber

Answer: ICD-9 divides neoplasms into two main categories: malignant (cancerous) and benign (non-cancerous). Within each main category, there are subclassifications.
 
A primary malignancy is one arising from the cells found where the physician biopsied the neoplasm.
 
A secondary neoplasm is the result of metastasis and forms a new focus of malignancy elsewhere, such as the
lymph nodes, liver, lungs or brain, or when the primary cancer has invaded adjacent structures.
 
In situ describes malignancies confined to the site of origin without invasion of neighboring tissues, although they can grow large enough to cause major problems.
 
Benign neoplasms are cancer-free. They may return after removal, but they are noninvasive.
 
Also, there are categories for "uncertain behavior" and "unspecified."
 
If the pathology report returns with indications of atypia or dysplasia, the neoplasm is "in transition" from benign to malignant and is therefore "uncertain." If the process continues and the mass is left untreated, the neoplasm could eventually become malignant.
 
You should use the "unspecified" diagnosis only when the pathologist cannot determine the nature of the neoplasm. This diagnosis would be very rare in the physician setting because you would normally wait for the biopsy report before assigning a diagnosis. One possible exception is when the physician destroys the lesion and there is no specimen to send to the lab. But the physician would usually take such a step only if he is sure he is not dealing with a malignancy.
 
Caution: If the pathologist labels the neoplasm uncertain, you shouldn't use an unspecified diagnosis, because "unspecified" implies that the physician's documentation didn't indicate the malignant lesion's type.