Wiki Cancer coding primary vs. secondary - My confusion.

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G
Code: C61

Code Name: ICD-10 Code for Malignant neoplasm of prostate

Block: Malignant neoplasms of male genital organs (C60-C63)

Includes: malignant neoplasm of skin of male genital organs

Details: Malignant neoplasm of prostate

Use additional code to identify:hormone sensitivity status (Z19.1-Z19.2)
rising PSA following treatment for malignant neoplasm of prostate (R97.21)

Excludes 1: malignant neoplasm of seminal vesicle (C63.7)

Guidelines: Neoplasms (C00-D49)

Note: Functional activity
All neoplasms are classified in this chapter, whether they are functionally active or not. An additional code from Chapter 4 may be used, to identify functional activity associated with any neoplasm.
Morphology [Histology]
Chapter 2 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes.
Primary malignant neoplasms overlapping site boundaries
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.
Malignant neoplasm of ectopic tissue
Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).

For more details on C61, ICD-10 Code for Malignant neoplasm of prostate , visit: https://coder.aapc.com/icd-10-codes/
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I haven't coded cancer for a practice before, as I'm usually coding for pain management, but these scenarios are subsequent hospital visits billing for physician visits. Below are the physician's ENTIRE dictation at each encounter, but I'm ONLY confused as to what I am coding for the CANCER. *No need to spend your time coding the others for me, thank you :) *

The patient with "Assessment A" had been previously coded by another coder at admit as C61- Malignant neoplasm of prostate ... I'm interpreting the following assessment as C79.82- Secondary malignant neoplasm of genital organ.

My general understanding of prostate cancer is that it will begin at the prostate and metastasize elsewhere (the spine, bones, etc.). My confusion is: Is "Metastatic prostate cancer" saying the prostate cancer is spreading elsewhere (as primary), or that the prostate cancer itself is metastatic (secondary).

I have other examples as well that have seemed to confuse me a bit. Can someone please advise on how I should read the cancer dictation, and possibly how to code these encounters for the cancer?

ASSESSMENT A:
1. Metastatic prostate cancer.
2. Thoracic spinal cord compression with metastatic prostate cancer status post laminectomy and fusion.
3. Incomplete paraparesis.
4. Neurogenic bladder.
5. Neurogenic bowel.
6. Leukocytosis.


ASSESSMENT B:
1. Incomplete quadriparesis secondary to metastatic prostate cancer of the thoracic spine.
2. T2-T5 laminectomy for excision of metastases with focal fusion.
3. Widely metastatic prostate cancer to the bone.
4. Dyslipidemia.
5. Neurogenic bladder.
6. Neurogenic bowel


ASSESSMENT C:
1. Metastatic renal cell carcinoma to the T10 vertebral body, status post laminectomy and spinal
decompression.
2. Postoperative epidural hematoma, status post evacuation.
3. Neurogenic bladder.
4. Neurogenic bowel.



ANY help would be greatly appreciated, as I seem to have confused myself at this point.

Thanks,

-Erica
 

erjones147

Expert
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Based on what you have posted, the prostatic cancer is primary and the spinal cancer is secondary

You'd code first for what is being dealt with primarily at that visit, which means that in some cases, you would code the secondary cancer ahead of the primary cancer

In your examples, I would code prostate only for A, spinal/prostate for B, and renal cell/spinal for C - but I would need to see the whole note to be 100% sure
 

rcrouch@crmchealth.org

Guru
Local Chapter Officer
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I work and code for a facility based cancer center. We code the cancer that we are treating as primary with the others following. If we were treating the bone mets, it would be coded first followed by the prostate and other cancer codes. If we were treating the prostate, it would be coded first. At times they may be receiving radiation to the spine and chemo for the prostate, the primary is whatever we are treating that day.

If I am coding for an office visit, I code the most recent metastatic site, followed by other mets and then the primary or history of code depending on the situation. In other words the most recent diagnosis first. If we are seeing the patient for a complication of treatment or of the cancer than the complication is coded first.

Hope this helps.
 

mitchellde

True Blue
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There is an old old coding clinic that really helps with this. It is he May/June 1985 if I remember correctly. With a statement such metastatic prostate cancer, you code the prostate as primary with an unknown secondary unless it is indicated. if it is a well known primary site such as prostate. If it said for instant metastatic bone cancer then the bone would be coded as the metastatic site with an unknown primary because bone cancer is more common as a metastatic than a primary. The coding clinic gave a list of those sites which are more common as a metastatic than a primary.
For the first example you gave, there was no real indication of the metastatic site although I assume it was the bone but you would need more clear documentation so you would go with unknown secondary.
 
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