Pulmonology Coding Alert

Question: Should we submit separate diagnoses for non-small cell lung cancer (NSCL) and small cell lung cancer (SCLC)? 

We currently only report 162.9. Is that incorrect?

Georgia Subscriber

Answer: No, you don’t need to submit separate diagnoses but should concentrate on specific tumor sites to accurately capture the code. 

Lung cancer is classified into four primary types, depending upon how the cancerous cells appear under a microscope: 

• Small cell lung cancer (SCLC), also called oat cell cancer (SCLC spreads rapidly and is more likely than other types to have metastasized)
• Squamous cell carcinoma, also known as epidermoid carcinoma
• Adenocarcinoma, which can reach the lymph nodes and other organs
• Large cell carcinoma, where those cells are considered that have not been diagnosed as squamous, adenocarcinoma or SCLC. 

You are correct in coding the primary malignant neoplasm of the lung as 162.x (Malignant neoplasm of trachea bronchus and lung), whatever the cell type, and the fourth-digit subcategory identifies the specific site of the cancer:

• 162.0 — Malignant neoplasm of trachea, bronchus, and lung; trachea
• 162.2 — …main bronchus
• 162.3 — …upper lobe, bronchus, or lung
• 162.4 — …middle lobe, bronchus, or lung
• 162.5 — … lower lobe, bronchus, or lung
• 162.8 — …other parts of bronchus or lung (This includes malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined.)
• 162.9 —…bronchus and lung, unspecified. 

Note: For carcinoma in situ of the lung, you should use diagnosis code 231.2 (Carcinoma in situ of respiratory system; bronchus and lung). 

After you have nailed down the carcinoma site, you also have to report the nonmalignant neoplasm’s behavioral pattern. Nonmalignant neoplasms of the lung are categorized as 212.3 (Benign neoplasm of respiratory and intrathoracic organs; bronchus and lung), 235.7 (Neoplasm of uncertain behavior of digestive and respiratory systems; trachea, bronchus, and lung) and 239.1 (Neoplasm of unspecified nature; respiratory system). 

If the cancer has metastasized to the lung — meaning, if the cancer has spread from another organ to the lung — you’ll code 197.0 (Secondary malignant neoplasm of respiratory and digestive system; lung).

Final word: Don’t oversimplify the correct diagnosis for NSCL or SCLC by simply assigning 162.9. Go through all documentation for the details you need to select the best code.