Pulmonology Coding Alert

Question: The physician documented that the patient has a primary neoplasm of the right lower lobe with metastasis to the left lung. Do both the left and right lungs fall under the primary code? Or should we report both a primary code and a secondary code?

Illinois Subscriber

Answer: When the physician documents a primary right lower lobe neoplasm with metastasis to the left lung, you should report:

• Right lobe: C34.31 (Malignant neoplasm of lower lobe, right bronchus or lung)
• Left lung: C78.02 (Secondary malignant neoplasm of left lung).

Caution: Don’t assume that the presence of a second neoplasm in the same organ system as a primary neoplasm means that you have both primary and secondary neoplasms. A patient may have two primary neoplasms in the same organ system. For example, if the patient had been diagnosed with cancer of the left lower lobe and metastasis to the right lung, peritoneum, and liver, then you would have submitted the following codes:

• C34.32 (Malignant neoplasm of lower lobe, left bronchus or lung)
• C78.01 (Secondary malignant neoplasm of right lung)
• C78.6 (Secondary malignant neoplasm of retroperi­toneum and peritoneum)
• C78.7 (Secondary malignant neoplasm of liver and intrahepatic bile duct).

Remember: Let the documentation guide your choice.