Wiki Negative Lymph Node Diagnosis?

[dimplez]

What is the appropriate diagnosis to use when the a biopsy is performed of the area lymph nodes to check for metastatic cancer and they return negative/benign? I have co-workers who are using DXXX codes (D36.0) rather than the primary cancer. I was trained that we use the cancer code as the lymph node is not actually a neoplasm.

Please see below path report example, if a resource code be provided (AHA coding clinic, CMS, etc) that would be GREATLY appreciated.
T. Posterior nasal margin at eustation tube: Involved by well
differentiated squamous cell carcinoma.
Intense chronic inflammation.
U. Cartilaginous eustation tube: Involved by well differentiated
squamous cell carcinoma.
Intense chronic inflammation and parakeratosis
V. Medial pterygoid: Involved by well differentiated squamous cell
carcinoma.

AE. Right cervical lymph nodes, level 2B: Eleven lymph nodes,
negative for tumor (0/11).
AF. Right cervical lymph nodes, level 2A: Seven lymph nodes,
negative for metastatic carcinoma (0/7).
Increased plasma cells and possible amyloid. Additional
studies pending.
AG. Right cervical lymph nodes, level 3: Nineteen lymph nodes,
negative for tumor (0/19).
AH. Right cervical lymph nodes, level 4: Eleven lymph nodes, negative
for tumor (0/11).
Poorly formed noncaseating granulomas.

Thank you

 

[thomas7331]

You are correct, if the lymph nodes are negative, then there is no diagnosis to assign from the pathology. D36.0 would be incorrect unless the pathology report had come back with a diagnosis of a benign neoplasm. If the lymph nodes are negative, you would need to code the reason for the biopsy, and since the provider is looking for possible metastasis of a known cancer, you're correct that you should code the primary cancer here.

 

[csperoni]

I'm coding from the surgeon perspective. Often pathology is not even resulted yet when coding.
I code primary dx of the known primary cancer. If there was any lymphadenopathy noted, I will code that as well. I have never coded D36.0 (or similar) for negative lymph nodes when there is a primary cancer. The lymph nodes were not removed because there is a neoplasm on the node. They were removed because the surgeon is concerned the primary cancer may have metastasized to the lymph nodes.
I would only use D36.0 if there was a situation of having a neoplasm on the nodes, and then pathology was benign.
If pathology was back and there were mets, I would code the 2ndary cancer as well.