Radiology Coding Alert

Here are some examples that will help you gain a better understanding of neoplasm coding. Also, learn what experts have to say for the diagnosis coding of neoplasms.

Scenario: Your radiologist documented a dense mass with convoluted outline in the lower lobe of the right lung. 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:

Your physician documented gadolinium-enhanced T1-weighted MR images obtained with fat suppression revealed nodules of mural thickening with moderately intense gadolinium enhancement. The report confirms a diagnosis of jejunal carcinoid. 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).