Lets get into come content. One of our students have asked to review neoplasm coding from the ICD 9 manual. so what this is… it does like someone chewed the corner, thatís my kids. TheyÖ I was working on this page and they came over. ìCan I help you color?î But in any rate, if you have your ICD 9 book handy, this is in the index if you go to the Ns for Neoplasm. The first thing you want to remember about cancer coding or neoplasm coding is the fact that really, you should not start with the neoplasm table. And this was kind of new for me. I had actually been teaching a couple of years before I actually realized that you should look for the main term in the document that youíre coding like melanoma or whatever.
You go to that first. 9 times out of 10, it will direct you to neoplasm and the table but always start with the main term that youíre trying to code and let the index direct you to the neoplasm table. So once you come to the neoplasm table, what I want you to look at first is these columns. Okay so thereísÖ in neoplasmÖ here you go, Jane.
Hereís medical terminology, right? Means new growth. It doesnít mean cancer. It could be but it means that thereís a new growth. So we see here that thereís 3 types of malignant cancers: primary, secondary, and cancer in situ. The primary type is itís a spreadable type of cancer. And secondary is where it spreads to so youíll see in the documentation, phrases like ëwith metsí. So maybe they had breast cancer with mets to the liver or with mets to the lungs or something like that.
So the primary cancer would be the breast and the secondary cancer would be the lungs or the liver. Okay, cancer in situ is cancer thatís not the spreadable type. Itís kind of encapsulated. Another instructor tells her students to think of an egg, itís like the yolk in an egg. So itís encapsulated, itís not going anywhere. Then weíve got benign neoplasms which is self-explanatory. Uncertain behavior, theyíre not sure theyíre watching it and then unspecified. They just know that itís a neoplasm but they donít know.
A lot of times, coders will wait for the path report to come back to code it as primary or secondary or whatever type cancer it is. But sometimes, they donít know. They donít plan on documentation coming back to code from so they code it as unspecified. So once you determine what type of cancer or neoplasm youíre dealing with, thatís the column that youíre going to use. So let me scroll down a little bit here. So letís just take abdomen and Iím just going to use the top row for illustration purposes. So if the cancer started in the abdomen, if that was the primary location, youíre going to pull from this first column. Encode at the 1because thatís the primary column. But letís say it spread toÖ Iím just trying to stay on the same page here.
But if it spread, if it was a secondary cancer of the abdominal pelvic area, letís say. Youíre going to code from the second column, 198.89. And thatís how easy it is to pull from these columns. They still turn to the tabular and look at the code definition and confirm that youíve got the right code that youíre looking for. Donít just code from the table. What gets confusing with secondary cancer coding and you might want to copy this into your book, for those that are in the Replay Club, youíll get a copy of this PDF hereÖ is secondary cancer coding. How do you handle that? If a patientís coming in for treatment of the secondary cancer, thatís going to go on the first position on the claim form.
Okay so youíre going to pull from the secondary column. Thatís going to go on the first position. Then the next logical question is well, since itís a secondary cancer, where did it come from? Where did it spread from? So that is going to go on the second position on the claim form, the second diagnostic slot. So if the primary cancer is still active then youíre going to pull from the primary column. Itís just going to go on the second position. If itís been excised and itís not under treatment, itís history ofÖ youíre going to use a V code. Maybe they had a mastectomy.
So then itís going to be hsitory of breast cancer and now youíre treating liver cancer. So you pull the liver cancer from the secondary column and for theÖ that goes in the first position and the second position on the claim form, youíre going to code the V code for history of breast cancer. If you donít know where it metastasized from because maybe youíre coding for radiology and they donít know. Theyíre just doing a brain scan or a liver scan. Then they have to use 1which I have circled here. Thatís the unspecified primary site. Okay so thatís how you handle the secondary cancer coding. Now another thing that I always like to let my students to be aware of is thisÖ in the note section, if you look at number 2 here, it says sites marked with the asterisk should be classfied as one of two things: either itís a malignant neoplasm of the skin or itís a benign neoplasm of the skin.
Now itís malignant if itís a squamous cell carcinoma. So if ithatís whatís documented you concider it malignant neoplasm of the skin. If itís an epidermoid carcinoma, same thing. Itís a malignant neoplasm of the skin. Now if itís a papilloma then thatís considdred a benign neoplasm. So make sure that you have this marked up for the skin ones. Let me see if thereís any starred ones on this page. No sorry, I donít have any examples. But it would be an asterisk and you know because sometimes, itíll be abdominal. Itís like, ìOkay, are you telling me about the skin of the abdomen or youíre talking about internal organs of the abdomen?î So thatís what the star would help you understand. Boyd: Do you go over this at all in the Blitz course? Itís just being asked by Linda.
ThatísÖ I do cover that in the Blitz because I do feel that that is a question that youíll be asked on the board exam, especially the secondary cancer coding..