Radiology Coding Alert

Question: What is the difference between a primary and secondary neoplasm? I'm confused about which code to use for a metastatic tumor once the original tumor has been removed.

Pennsylvania Subscriber

Answer: Continue to report the metastatic tumor as "secondary" even if the primary tumor has been eradicated.

Primary: A primary neoplasm code indicates the original tumor site.

Secondary: A secondary neoplasm indicates a site to which the cancer has spread.

History of: According to ICD-9 2009 official guidelines (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm), if the patient's tumor is eradicated and no longer requires treatment, you should use a "history of" code, such as V10.3 (Personal history of malignant neoplasm; breast).

Here's the exact language: "When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary  malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code" (page 24).