General Surgery Coding Alert
Capture Primary Plus Metastatic Cancer
Question: What are the correct diagnosis codes for malignant breast cancer with metastasis to liver and bone?
Answer: You should report the breast cancer first using a primary malignant neoplasm code. You also need to list secondary neoplasm codes for the liver and bone metastasis.
Breast: The medical record should identify the location of the tumor to allow you to use the most specific diagnosis code for that site, such as 174.1 (Malignant neoplasm of central portion of female breast). If documentation doesn’t show the specific location, the correct code for the breast cancer is 174.9 (Malignant neoplasm of breast [female] unspecified site).
Under ICD-10-CM, the code will vary based on the breast involved (for example, C50.111, Malignant neoplasm of central portion of right female breast).
Metastatic sites: You also should code the metastatic cancer. You mentioned liver, which you should report as 197.7 (Malignant neoplasm of liver secondary). For the bone metastasis, report 198.5 (Secondary malignant neoplasm of bone and bone marrow).
Under ICD-10-CM, look to C78.7 (Secondary malignant neoplasm of liver and intrahepatic bile duct) and C79.51 (Secondary malignant neoplasm of bone) or C79.52 (Secondary malignant neoplasm of bone marrow).
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General Surgery Coding Alert
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