carcinoid/neuroendocrine tumors


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Why did the ICD make these the only tumors with no unspecified or uncertain behavior categories, when they're the very ones that are virtually NEVER specified as one or the other? Some sources sound like they're all cancer, some very slow-growing others not. Just about all cite the name "carcinoid" as having been given to them to point out their status as being BETWEEN benign and malignant (or so it was thought at the time). Some say WHO d/c'd "carcinoid" 10 yrs ago in favor of "neuroendocrine" but look what's in the ICD!?! Oh, and one or more sources day secondary doesn't necessarily mean malignant - well that IS the one place the ICD actually DOESN'T say benign or malignant - in the secondary neuroendocrine tumors section. One of my docs doesn't like the description "benign carcinoid" as a contradiction in terms. So on and on. If the pathologists are unwilling to commit on these things, how can we coders be expected to make the determination? Sure, you can go to the residual category 209.60 "benign carcinoid tumor of unknown primary site", but we DON'T know that it's benign...........What a mess they made of adding this section!
OK, that's my vent for the day!