Oncology & Hematology Coding Alert

Question: What changes can we anticipate for diagnosis coding for malignant bronchial neoplasms? Our physician diagnosed a malignant bronchial neoplasm for a patient who has been a chronic smoker. How can we report for the smoking history in this patient?

Washington Subscriber

Answer: From your description, it seems that your physician diagnosed a malignant neoplasm in the main bronchus. For this, you have options in both ICD-9-CM and ICD-10-CM. In addition, both the ICD-9-CM and ICD-10-CM options indicate that the codes are appropriate for malignant neoplasms of the carina or hilus of lung.

ICD-9-CM Code: ICD-9-CM offers a single code, 162.2 (Malignant neoplasm of main bronchus), for malignant neoplasm of the bronchus.

ICD-10-CM Options: ICD-10-CM, on the other hand, offers options specific to location in the right or left bronchus.

• C34.01 -- Malignant neoplasm of right main bronchus
• C34.02 -- Malignant neoplasm of left main bronchus.

When your physician does not document the laterality in case of malignant neoplasm of the bronchus, you report code C34.00 (Malignant neoplasm of unspecified main bronchus).

Do not miss tobacco exposure: Because your physician has documented the habit of smoking in the patient, you also submit code Z72.0 (Tobacco use) or Z87.891 (Personal history of nicotine dependence) depending on the explanation of tobacco use and timing.

Below are even more exposure to tobacco choices in ICD-10-CM.  Assign the correct ICD-10-CM code as supported by the physician’s documentation: 

• Exposure to environmental tobacco smoke (Z77.22)
• Exposure to tobacco smoke in the perinatal period (P96.81)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Nicotine dependence (F17.-)