Icd 9 Code For Metastatic Lung Cancer. Okay so someone had wanted to review cancer codes and ICD 9? And Iíve had a hard time picking which one to use, benign, malignant or not specified. SoÖ and what I did was I just did kind of a basics in cancer coding. So metastatic means that itís moved. So you know, think M ñ move, M ñ metastatic. The cancer has moved from one place to another so thatís usually from one organ to another. So weíve got like breast cancer has metastasized to the lung and the cancer started in the breast and now itís moved to the lung.
So when people talk about that, theyíll say the first cancer or the primary cancer. So common metastatic sites are lymph nodes, bone, lungs and brain. So in other words, if a person has cancer and theyíre going to get a secondary cancerÖ in other words, itís going to move somewhere else in the body, it usually goes to the lymph nodes, bone, lungs and brain. And actually, when you think about cancer, I used to tell my students, cancer is just cells that are not growing normally anymore, cells growing a certain way.
But when theyíre not growing normally, they mutate. So letís say if for example, you say your cell is a circle and then itís reproducing itself. But then all of a sudden, one produces it as a square. Okay well, it doesnít line up and work with the other cells because itís a square. SoÖ and thatís fine. That would be you know, benign cancer. But when all of those square cells start deciding to reproduce themselves instead of making circle squaresÖ circles, theyíre making squaresÖ then thatís cancer. And then once those cancer cells learn how to do that, they start teaching other cells how to do that and thatís how it spreads. So if a person has metastatic cancer, both sites need to be coded. When thereís documentation for a primary or a secondary cancer but the site is not indicated, you use this magic little default code for cancer which is 199.1. And that code indicates that there is another cancer, whether primary or secondary but you donít know what it is. And youíll see terminology like that that will state you know, metastatic cancer to the lung.
Okay well that means thatís a second cancer, moved to the lung. But where did it come from? I donít know. I donít have any documentation on that. So it would be 199.1. And if you reverse that and say you know, she has breast cancer and it has metastasized. Okay so you can code the breast cancer. Where did it go? I donít know. Thereís no documentation. 1takes care of that. So thatís your default code when you donít know and it works for primary or secondary. So if we scroll down a little bit moreÖ so plain English, use this code for malignant neoplasms of an unspecified site, both primary and secondary. It goes both ways. So what is benign? The term benign refers to a condition thatís a tumor or growth that is not cancer.
So you got all those little circle cells and all of a sudden, they mayÖyouíve got like 3 square cells. Well, theyíre not doing anything but you know, they may go ahead and remove it and check and make sure itís not trying to replicate itself. But if it doesnít then itís considered benign. Itís a tumor, it may be something that someone doesnít want or causes problems. Thatís another thing. Just because itís benign doesnít mean itís going to cause problems. It just means that itís not going to spread someplace. But it can still bother other tissue. So in general, benign tumor grows slowly and is not harmful. However, in some cases, you have benign tumors that grow big enough to be found near blood vessels or in the brain or the nerve or different organs that need to be removed because theyíre causing a problemÖ because there cells donít need to be there or their size is hindering some function of that organ.
Theyíre not metastatic. Theyíre not trying to teach other little cells to be like them. They are just in the way, more or less, so theyíll be removed. Thatís the difference between benign and malignant. You want to make sure you know whether itís benign or malignant. And most physicians are very good about documentation and theyíll say benign tumor of the breast or malignant mass in the lung. You know, soÖ but you canít code one way or the other unless you have a definitive diagnosis. So you need to make sure you find out from your provider which one it is. Okay, unspecified. Well that just means you donít know. So if there is no documentation to state that it is either metastatic or benign or it hasnít metastasized, thereís no verbiage thereÖ youíre going to put unspecified. Sometimes, the doctor may not know yet. The pathology report hasnít come back and so he will say that you know, he doesnít know. And then you would use that unspecified code. You donít really want to use the unspecified code unless you have to because you want to code to the highest specificity and your insurance companies are going to like unspecified most likely.
So you want to make sure that you have that. And a little trick to know though is that if a past report is available and your document for your op report states that you know, he doesnít know the tumorís been sent off, the pathology comes back and itís malignant, you can code malignant for that op report because you have the documentation now to back it up. So thatís something to keep in mind. Pathology reports trump what the op report said because itís a definitive diagnosis given by a provider. And letís see, one more thing to remember about coding the cancer codes isÖ is there more underneath there? No, no thatís the end of it now, Laureen.
Laureen: Oh youíre right. Alicia: Yeah, I thought it said more. Thereís tumor registries now and so whenever you see a term like lymph node involvement, that means the cancerís moved into the lymph nodes. Okay so when youíre doing tumor registry, once the person gets diagnosed with cancer, theyíre going to do staging. And youíll hear people say itís stage 4 or itís a stage 1. So this is called TNM staging. Tumor forÖ itís a tumor, Lymph Nodes and Metastasis ñ M and those will get numbers behind them. And that is basedÖ they do that for statistics. And in fact, a lot of times youíll see jobs that are tumor registry coders. Hospitals will have them just so they can take care of the coding thatís done just for the staging and the treatment of a cancer. Now this is another note that you need to know when youíre doing the cancer coding. If a person no longer has active cancer because itís been eradicated, removed or previously excised, you can use a history code to indicate the person had cancer.
I think we did this in another webinar because weíd had a question about history codes. This is a V10 code and is divided up to different body systems, V10 something. Remember, you cannot use a history code if the person is getting actively treated for the cancer. Now a lot of times, people will get confused. People will say, ìWell you know, she had a mastectomy and sheís not getting chemo and sheís not getting radiation.í She doesnít have cancer. But the doctor put her on a medication to make sure the cancer doesnít come back. So sheís technically still getting active treatment for the cancer. And this would be V58.69. Sheís getting long term use of this medication. And if you scroll down, I think Iíve listed some of the medications just so youíll be familiar. I think Tamoxifen was one of them. Here we go. Herceptin, Tamoxifen is one you see a lot and some of those others which Iím not even going to try to pronounce. But those are medications that doctors will give for different types of cancer after the personís no longer getting chemo or radiation.
Theyíve removed the mass, the cancer mass but they want to make sure that the tumor doesnít come back. And you can be on one of these medications for years. And up to, I think, 8 years or something. I think some women take Tamoxifen for the breast cancer. So the guidelines stateÖ and this was a question that came up a few years ago is if youíre gettingÖ if the patient is getting treated with Tamoxifen, are you able to use a history code for them onÖ because they technically do not have cancer? And the answer was no, you cannot use a history code if theyíre actively being treated for the cancer and technically, they were.
So keep that in mind and thatís kind of the basics about ICD9 coding for cancer. Get more cpc exam tips, coding certification training and ceu credits. Go to http://www.codingcertification.org.