Oncology & Hematology Coding Alert

Question: The oncologist's documentation confirms the pathologist's diagnosis of primary malignant neoplasm of the colon. The resection specimen included a portion of the hepatic flexure and transverse colon, but the pathologist reported he couldn't pinpoint the origin of the cancer. What diagnosis code(s) should we use?

Kentucky Subscriber

Answer: Report 153.8 (Malignant neoplasm of other specified sites of large intestine) for this case. Colon or colorectal cancer can start in the large intestine (colon) or the rectum (end of the colon).

Although the resection includes specific sites that have their own cancer codes, 153.1 (Malignant neoplasm of transverse colon) and 153.0 (Malignant neoplasm of hepatic flexure), you should not select either of those codes.

Here's why: Because documentation does not specify the location of the cancer within the specimen, you can't select one of the more specific codes. Instead, you should use 153.8. An ICD-9-CM text note indicates that the code represents "malignant neoplasm of contiguous or overlapping sites of colon whose point of origin cannot be determined."