Wiki ICD 10 Coding, unable to biopsy

[SDBrunner]

Hello,
This is a POS 11 setting.

Pt has a hx of right lung cancer with a new left lung "cancer". There are comorbidities so it's too risky to biopsy. I was taught at my first oncology job that if a biopsy cannot be performed then we can code as the assumed cancer. I can't find anything to support this.

The doctor does not state "assumed" cancer. he states LLL cancer, too risky to biopsy.
The referring provider states "strongly suspected" LLL cancer.

So do I code as confirmed LLL lung cancer, D38.1, or just R91.8?

 

[sls314]

Hello,
This is a POS 11 setting.

Pt has a hx of right lung cancer with a new left lung "cancer". There are comorbidities so it's too risky to biopsy. I was taught at my first oncology job that if a biopsy cannot be performed then we can code as the assumed cancer. I can't find anything to support this.

The doctor does not state "assumed" cancer. he states LLL cancer, too risky to biopsy.
The referring provider states "strongly suspected" LLL cancer.

So do I code as confirmed LLL lung cancer, D38.1, or just R91.8?

Don’t use an uncertain behavior diagnosis code (D38.1). That code is only appropriate when a pathologist has reviewed a biopsy and is unable to determine whether the neoplasm is benign or malignant.

If the oncologist is making a clinical determination that it is cancer and has documented their medical reasoning, then you should report the appropriate C code.

 

[SDBrunner]

ok thank you! Yes I spoke too early and should have said D49.1, not D38. But I do understand what you are saying. Thank you again!