Oncology & Hematology Coding Alert

You report tumor in fourth ventricle with brainstem tumor code.

Do you have an impression of a direct match for brain tumor codes in ICD-10? You may be wrong. Find the exception by checking your answers with answers from experts.

Answer 1: The correct option is c. (C71.3)

When reporting a neoplasm in the brain, location is your key. ICD-10 has a one-to-one match for tumors in the lobes of the brain.

ICD-9: For malignant neoplasms of the brain, you choose code under 191.x depending upon the anatomic location of the tumor.

ICD-10: ICD-10 offers identical groupings for brain neoplasm codes.

You report ICD-9 code 191.1 (Malignant neoplasm of frontal lobe), 191.2 (Malignant neoplasm of temporal lobe), 191.3 (Malignant neoplasm of parietal lobe), or 191.4 (Malignant neoplasm of occipital lobe) depending upon which lobe the tumor was located in. The corresponding ICD-10 codes include C71.1 (Malignant neoplasm of frontal lobe), C71.2 (Malignant neoplasm of temporal lobe), C71.3 (Malignant neoplasm of parietal lobe), and C71.4 (Malignant neoplasm of occipital lobe), respectively.

Important: You will also need to check for tumors in other sites. When you report cerebral tumor in a location other than the lobes or ventricles, i.e. tumors in structures like the basal ganglia, cerebral cortex, corpus striatum, globus pallidus, hypothalamus, and thalamus, you report ICD-9 code 191.0 (Malignant neoplasm of cerebrum except lobes and ventricles). The corresponding ICD-10 code is C71.0 (Malignant neoplasm of cerebrum, except lobes and ventricles) lists only malignant neoplasm of supratentorial NOS. Supratentorial refers to the area of the brain above the tentorium cerebelli, a membrane layer that separates the cerebrum form the cerebellum.

Answer 2: The correct option is b. (C71.6)

When reporting a tumor in the cerebellum, you again have a one-to-one match in ICD-10. You report ICD-9 code 191.6 (Malignant neoplasm of cerebellum NOS) and ICD-10 code C71.6 (Malignant neoplasm of cerebellum) for the tumor in the cerebellum.

Tip: You also have a one-to-one match for brainstem tumor. You have ICD-9 code 191.7 (Malignant neoplasm of brain stem) and the corresponding ICD-10 code C71.7 (Malignant neoplasm of brain stem).

Documentation: Your physician needn’t change any practices is documentation as the codes in ICD-10, like those in ICD-9, are location specific. It is good to specify that the tumor is a primary tumor. This will support and simplify the choice of a specific code.

Answer 3: The correct option is a. (C71.9)

When your physician does not specify the site of the brain tumor, you report ICD-9 code 191.9 (Malignant neoplasm of brain unspecified site). The corresponding ICD-10 code is C71.9 (Malignant neoplasm of brain, unspecified).

Answer 4: The correct option is b. (C71.8)

You have to be specific for ‘overlapping’ sites in ICD-10. You report ICD-10 code C71.8 (Malignant neoplasm of overlapping sites of brain) for tumor with overlapping sites in the brain.

Remember: In ICD-9, the descriptor of code 191.8 (Malignant neoplasm of other parts of brain) reads ‘other parts of brain. The descriptor of the corresponding ICD-10 code, C71.8 reads ‘overlapping sites of brain.’ Hence, the ICD-10 code is a more specific choice.

Answer 5: The correct option is d. (C71.7 Fourth Cerebral Ventricle)

An important change in brain tumor coding in ICD-10 is that you should watch the change for tumor in the 4^th ventricle.

When reporting a tumor located in the ventricle(s), you turn to ICD-9 code 191.5 (Malignant neoplasm of ventricles). This code applies to all ventricles, be it lateral, third, or fourth ventricles. In ICD-10, however, you report code C71.5 (Malignant neoplasm of cerebral ventricle) for the lateral and third ventricles and code C71.7 (Malignant neoplasm of brain stem) the notes under this ICD-10-CM code indicate it is also to be used for a "malignant neoplasm of the fourth cerebral ventricle."