Use These 2 Codes for Pancoast Tumor Pain Management
Question: We treated a patient for severe pain due to a Pancoast tumor. How should I code this diagnosis? Revenue Cycle Insider Subscriber Answer: If you look in the ICD-10-CM Alphabetic Index, you will not find an entry for a Pancoast tumor. Nor will you find an entry for a superior sulcus tumor (SST), which is another name for it. However, you will find an entry for Pancoast’s syndrome or tumor, which leads you to C34.1- (Malignant neoplasm of upper lobe, bronchus or lung). This perfectly describes the location of the neoplasm’s etiology, as it starts in the upper lung above the first rib. The term is listed in ICD-10-CM as a syndrome as “people with Pancoast tumors almost always develop shoulder pain accompanied by arm weakness and other symptoms … [a] collection of symptoms … providers call ‘Pancoast syndrome,’” according to Cleveland Clinic The syndrome causes severe pain in the shoulder, down the arm, in the neck, and the upper ribs, hence the patient coming in for pain treatment. As that treatment is the reason for the encounter, you will also need to code G89.3 (Neoplasm related pain (acute) (chronic)) in addition to C34.1-. You will use the code regardless of whether the provider uses either “acute” or “chronic” to describe the patient’s pain, and you will also use the code as the primary, or first-listed, code for the encounter. That’s because ICD-10-CM Guideline I.C.6.b.5 tells you the code “may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis.” This is despite the lack of Code also instructions for G89.3. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
