Oncology & Hematology Coding Alert

Question: Which is the appropriate ICD-9 code for micropapillary ovarian cancer?

Delaware Subscriber

Answer: The only ICD-9 code describing primary ovarian cancer, including micropapillary, serous, mucinous, endometroid, squamous, and clear cell, is 183.0 (Malignant neoplasm of ovary and other uterine adnexa; ovary).

If, however, the physician identifies the ovarian cancer as secondary to another cancer, you would instead apply 198.6 (Secondary malignant neoplasm of other specified sites; ovary). Keep in mind, however, that you may see more than "primary" and "secondary" ovarian cancers.

You may also see documentation describing "borderline tumors," "low malignant potential" lesions, or "atypical proliferative tumors." If your oncologist only uses one of these terms to describe the tumor, check for more details before you code.

A borderline tumor with no invasion may merit 236.2 (Neoplasm of uncertain behavior of genitourinary organs; ovary) or 220 (Benign neoplasm of ovary).

However, you might better describe a borderline lesion with invasive implants using 233.39 (Carcinoma in situ of breast and genitourinary system; other female genital organ).

Ask for specifics: If the physician's documentation isn't specific, ask for more details. Whenever possible, you should avoid nonspecific diagnoses such as 183.8 (Malignant neoplasm of ovary and other uterine adnexa; other specified sites of uterine adnexa) or 183.9 (... uterine adnexa, unspecified) for a malignant neoplasm, or 625.8 (Other specified symptoms associated with female genital organs) for an "ovarian mass."

ICD-9 code 183.0 includes a note to "Use additional code to identify any functional activity." This means that if the patient is also experiencing abnormal bleeding or other problems, you should assign additional diagnosis codes to report these conditions.