Oncology & Hematology Coding Alert

Question: Our oncologist performed a fine needle aspiration (FNA) on a patient’s right neck for a lymph node biopsy. The note read, “direct smear preparations and cell block show a population of cytologically malignant squamous epithelial cells amid necrotic material and inflammatory cells.”

I don’t know what ICD-10-CM code to assign for this. The closest I get is C77 but that is metastatic. What is the correct code?

AAPC Forum Participant

Answer: In this case, a code from C77.- (Secondary and unspecified malignant neoplasm of lymph nodes) would not be accurate because, as you correctly say, you would use this for secondary, or metastatic, lymph node cancer. The Excludes1 note under C77.- tells you to instead look to C81-C86, C88, C96.0- for a malignant neoplasm of lymph nodes specified as primary.

In your case, one of two codes may be appropriate for primary cancer of the lymph nodes. Dependent on provider documentation, you could use either C96.Z (Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue), assuming the provider has specified the type of lymph node cancer, and a code from C96.0 through C96.A does correlate to the documentation. You could also possibly use C96.9 (Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified) if the lymph node cancer cannot be specified.

Don’t forget: You’ll use 10021 (Fine needle aspiration biopsy, without imaging guidance; first lesion) for the FNA, again assuming the provider did not use imaging guidance and also assuming the provider only biopsied one lymph node