Pathology/Lab Coding Alert

Use these clinical examples to sharpen your skills

You're faced with an outpatient pathology report that provides both clinical and pathology diagnostic information - how do you choose the correct ICD-9 code? Try your hand at coding the following scenarios, then compare your answers to our experts' advice. Example 1:
Clinical History: Dyspnea, rule out pneumonia.
Specimen source: Pleural fluid.
Final diagnosis: Pathologist review of cytospin slide shows many tight clusters of large cells with pleomorphic nuclei, high N/C ratio consistent with metastatic carcinoma of pleura.

Correct codes: The pathology report describes and names metastatic carcinoma of pleura as the diagnosis: 197.2 (Secondary malignant neoplasm of pleura). For a secondary malignancy, you must always code the primary malignancy too, which this pathology report does not specify. Use 199.1 (Malignant neoplasm without specification of site; other) for the primary malignancy from an unknown site. Example 2:
Clinical History: Asymptomatic screening Pap smear, Medicare patient.
Specimen source: Cervical Pap smear.
Final diagnosis: Initial screening indicates abnormal findings. Pathologist review indicates atypical squamous cells of undetermined significance.

Correct codes: V76.2 - Special screening for malignant neoplasms; cervix. Sequence as the second diagnosis code, 795.01 - Pap smear of cervix with atypical squamous cells of undetermined significance (ASC-US). Example 3:
Clinical history: Lung nodules, colon cancer treated with radiation.
Specimen source: Lung nodule, fine needle aspiration.
Diagnosis: Lung nodule FNA: positive for malignant cells. Adenocarcinoma, consistent with metastatic colorectal adenocarcinoma.

Correct codes: Code this metastatic lung neoplasm as 197.0 (Secondary malignant neoplasm; lung). Next, code the primary colon neoplasm as 153.9 (Malignant neoplasm of colon, unspecified).

- ICD-9 coding for the scenarios was prepared with the assistance of Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.; and Pamela Younes, MHS, HTL (ASCP), CPC, assistant professor at Baylor College of Medicine in Houston.