Pathology/Lab Coding Alert

ICD-10:

Location Drives Lung Cancer Diagnosis Changes

Published on Tue Jul 07, 2015

Laterality adds specificity.

Coding for lung cancer won’t change too much when ICD-10 goes into effect, if you can learn to lock in the location information from the pathology report.

Regardless of cell type, ICD-9 provides a single category for primary malignant lung neoplasm: 162.x (Malignant neoplasm of trachea bronchus and lung), with the fourth-digit subcategory identifying the specified site of the cancer, as follows:

0 — trachea

2 — main bronchus

3 — upper lobe, bronchus or lung

4 — middle lobe, bronchus or lung

5 — lower lobe, bronchus or lung

8 — other parts of bronchus or lung (includes malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined)

9 — bronchus and lung, unspecified.

Differentiate Trachea, Lung

ICD-10 provides two distinct categories for trachea versus lung or bronchus for the malignancy site, as follows:

C33 — Malignant neoplasm of trachea

C34 — Malignant neoplasm of bronchus and lung

ICD-10 further subdivides C34, with the fourth-digit subcategory identifying the specified site of the cancer, as follows:

0 — main bronchus

1 — upper lobe, bronchus or lung

2 — middle lobe, bronchus or lung

3 — lower lobe, bronchus or lung

8 — overlapping sites of bronchus and lung

9 — unspecified part of bronchus or lung

There’s more: ICD-10 requires a fifth digit for each of the above subcategories (except C34.2) to account for specimen site laterality. Use one of the following as a fifth digit for the codes: