Orthopedic Coding Alert

Question: Our surgeon performed a femur biopsy, and the pathology report came back as "metastatic poorly differentiated adenocarcinoma consistent with metastasis from prostatic primary." Which CPT and ICD-9 codes should I report for the biopsy?

Michigan Subscriber

Answer: You should report 20245 (Biopsy, bone, open; deep [e.g., humerus,  ischium, femur]) for the surgeon's work performing the biopsy.Because the neoplasm was a metastasized form of cancer, you should report a secondary neoplasm code as your primary diagnosis. Based on the information you received from the lab, your best bet would be 198.5 (Secondary malignant  eoplasm of other specified sites; bone and bone marrow). You should append 185 (Malignant neoplasm of prostate) as your tertiary diagnosis to show the payer that the patient has primary prostate cancer.