General Surgery Coding Alert

Improper coding of cancer diagnoses can negatively impact reimbursement and the patient's ability to obtain insurance. To ensure that the correct code is selected, you should wait for the pathology report to return and become familiar with the table of neoplasms appearing in ICD-9 before billing. Correct coding of cancer diagnoses is difficult for many reasons. The ICD-9 table of neoplasms is a 27-page list of thousands of codes that can prove intimidating at first sight. Although the table is comprehensive and breaks down codes alphabetically according to body area, the correct body area may be difficult to locate because a single area may include many subcategories.

Once you have located the proper body part, you will see all six neoplasm categories and corresponding codes listed to the right on the same line. Categories of Malignant Neoplasms The first three categories apply to neoplasms that the pathology report indicates are malignant. "A surgeon can't be 100 percent sure that the mass is malignant until it comes back from the path lab, so no ICD-9 code should be chosen until the specimen returns with a report," says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.

The pathology report also determines the type of malignancy, an important factor to consider when selecting the correct ICD-9 code.

Malignant neoplasms are categorized as follows: Primary. A primary malignancy code is used when the cancer originated at the body part in question. For example, if a female patient has a breast lump in the lower-inner quadrant that is found to be malignant and she has never had cancer before, a primary malignant neoplasm code (174.3) should be noted. However, the surgeon cannot be certain that a neoplasm is primary until the pathology report returns. Even though the patient has no history of cancer, the malignancy may have originated elsewhere but manifested in the breast. Secondary. These codes are used when the neoplasm is the result of metastasis and forms a new focus of malignancy elsewhere, such as the lymph nodes, liver, lungs or brain. For example, if the surgeon removes a lump from the chest wall beneath the previous mastectomy and the pathology report returns as a secondary malignancy with the breast as the origin, a secondary neoplasm code (198.89) should be used. In Situ. The term in situ is used to describe malignancies in their infancy. These codes are used when the neoplasm is "confined to the site of origin without invasion of neighboring tissues," according to Dorland's Medical Dictionary. This means that once an in situ mass is removed, there is no danger of any residual malignancy left behind. Unfortunately, this does not apply to some [...]