Wiki Small Cell vs Neuroendocrine

[KMayercsik]

We have a patient sent to us from a cancer center in a different state. The doctor diagnosed it as small cell carcinoma of the esophagus, mets to the brain. Histology is small cell neuroendocrine. The pathology states small cell neuroendocrine carcinoma. It was coded 209.79 & 209.30, and is being denied because these codes are not covered for Radiation as per our local Medicare LCD. Should it be coded for metastatic esophageal or 198.3 (brain mets) from V10.03 (hx of esophagus).
Any and all comments will be appreciated.

 

[kbazarte@yahoo.com]

what area are you treating w/ XRT?

is it brain mets w/ hx of esophogeal ca or is the esophagus ca currently being treated?

Are there two path reports one reporting small cell carcinoma and one reporting small cell neuroendocrine?

 

[k-jag]

I could be wrong on this, but I believe we are instructed by ICD-9 to code the location of the malignancy (esophagus), not the histology (neuroendocrine). So for malignant neoplasm of esophagus, primary I would use 150.x, and secondary malignant neoplasm of bone 198.5. If the radiation therapy is being directed at the bone neoplasm then 198.5 should be the first listed diagnosis used in conjunction with the XRT for billing.