Look to Neuroendocrine Features for Correct SCC Coding
Question: In my research I have learned that small cell carcinomas are considered a neuroendocrine cancer, but the ICD-10-CM code book directs us to code the condition as a C34.- instead of a C7A.- code. Why is that? AAPC Forum Participant Answer: You are correct in saying that small cell carcinoma (SCC) is a form of neuroendocrine tumor. SCC is distinguished from other carcinoids by its swift growth and ability to metastasize, according to MedlinePlus This makes SCC particularly difficult to treat, particularly when it is not detected early, which is often the case. Assigning a definitive diagnosis code for the condition can be especially challenging as the ICD-10-CM Alphabetic Index entry for Carcinoma/small cell directs you to C34.90 (Malignant neoplasm of unspecified part of unspecified bronchus or lung). However, you should code SCCs that exhibit neuroendocrine features (NEF) to C7A.- (Malignant neuroendocrine tumors). Why? This is consistent with the advice provided by AHA ICD-10 Coding Clinic Vol. 10, No. 1 (2023), which says, “documentation of small cell lung cancer or SCLC with neuroendocrine features is considered a neuroendocrine tumor.” The article goes on to tell you to code C7A.1 (Malignant poorly differentiated neuroendocrine tumors) for a diagnosis of SCLC with NEF. The article notes, “It is appropriate to assign C7A.1 since SCLC originates in neuroendocrine tumors within the lung and a neuroendocrine carcinoma described as small cell is considered poorly differentiated.” Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
