Learning opportunity!!!
After reading in the tabular a little further, my theory has narrowed down a little....I definitely don't think it's ca in situ anymore, and I'm torn between a couple of codes...I'll explain my train of thought - somebody please let me know whether or not my logic's correct:
First, I remembered that this is a path report for a chest wall lesion, which really makes me want to lean toward 195.1 - Malignant neoplasm of thorax (chest wall) NOS - the 'includes' note under 195 is making me second guess that, though, because it says "malignant neoplasms of contiguous sites, NEC,
whose point of origin cannot be determined"
Here's what's throwing me off:
1. When I hear the word "invasive", I think "aggressive", but more in the sense that, something is aggressively taking over (invading) something else. That almost aounds like a metastasis, to me; if this chest wall lesion is a metastasis, it would be 198.89; but, I can also see how it might just mean 'aggressive', in general.
2. 'Poorly differentiated', sounds to me, like the
point of origin can't be determined, which contradicts my theory on 'invasive' possibly meaning 'metastasis'; and supports my original thought of 195.1
3.Also, I'm not sure how much weight to give to the statement "consistent with..." in this situation; normally, I'd say that 'consistent with', symbolizes a certain degree of confidence, that you know what you're dealing with: it's not just a hunch; a
probable hunch...
So, it would almost be like the note could be saying:
"This chest wall lesion is an aggressive, malignant neoplasm, and we're not sure exactly where it originates from, but it's consistent with an aggressive malignancy of the breast, so we're going to consider it a malignant neoplasm of the breast." (in other words, "this is probably aggressive breast cancer, but we can't tell where it started.")
But, I could just as easily read the same statement as:
"This chest wall lesion is an invasive malignant neoplasm (of the chest wall), and it's difficult to tell where it originates from, but it's consistent with being a metastasis (eg, an invasion) of an aggressive malignant neoplasm of the breast." (in other words - "this cancer on the chest wall probably spread from some aggressive breast cancer")
So I guess my biggest question on this (aside from whether or not I understand what 'invasive' and 'poorly differentiated' mean in context), would be: If the lesion is on the chest wall, and it's cancerous, but resembles breast cancer, are they saying that it
is breast cancer, or that it started out that way, and spread to the chest wall?
Sorry if any of that sounded dumb... (Please be patient with me!
)
I don't get many opportunities to code oncology stuff, so I'm ignorant on the subject...And when I want to learn something, I have to list out all of my logic, so I know where I went wrong in my thinking, if necessary. So...can anyone tell me if my guess is even remotely correct, somewhere?