Question Clinical Indication of Lung Metastasis

Mesa, AZ
Best answers
I am working on a practice test for auditing thru the AAPC. One of the questions includes this in the documentation:

"Clinical Indication: Non-small-cell lung cancer with suspected metastasis"

also from the medical record:

"CONCLUSION: 1. No finding suggestive of metastatic disease."

One of the correct ICD-10 codes according to the answer key is C34.90, Malignant neoplasm of unspciefied part of unspecified bronchus or lung.

I disagreed with this code since the diagnosis is not of cancer. And we code post diagnosis codes, not preliminary diagnosis.

What input do people have for helping me understand the correct listed code of C34.90, please?
My reading of an indication of "Non-small-cell lung cancer with suspected metastasis" would be that the lung cancer - the primary malignancy - is a confirmed diagnosis, and that the patient is suspected of having metastasis. In other words, the patient is being evaluated to determine whether or not there is a secondary malignancy where the lung cancer has spread to another part of the body. Since with the final conclusion stating that there is no finding of metastasis, that means that there is no secondary malignancy, and you would just code the primary lung cancer C34.90 that is documented in the indication for the encounter. Hope that helps to clarify?
The patient has known lung cancer. Whatever was done showed no evidence of metastatic disease so you code the known primary, no secondary (metastatic) site of disease. There is no specific location indicated for the primary so C34.90 would be correct in this instance.
What I hear you saying, Thomas and Trarut is that the lung is cancerous, according to the Clinical Indication. And the Conclusion indicates that the existing lung cancer has not metastesized. So there is cancer. And it's not spreading. So C34.90 is correct. Thank you.

Here's the whole problem, fyi:

Patient: T. Greenwald Date of Service: 06/28/XX
DOB: 10/06/19xx
MR#: 852456
Account #: 3216678
Location: XYZ Outpatient Center

Clinical Indication: Non-small-cell lung cancer with suspected metastasis
Study: CT BRAIN/HEAD W/WO CONTRAST EXAM: CT Head, without and with Contrast August 5, 20XX.

TECHNIQUE: Axial images of the calvarium without and with 125 cc Omnipaque-300 intravenous contrast.

FINDINGS: The calvarium is intact. Imaged upper portions of the maxillary antra show minimal mucosal thickening. The sphenoid ethmoid and frontal sinuses are clear bilaterally. No hydrocephalus, mass effect, brain shift, abnormal extra-axial fluid collection or mass. Calcification left basal ganglia without mass effect, nonspecific, likely benign. Abnormal but nonspecific decreased density in the periventricular and subcortical white matter of the cerebral hemispheres bilaterally without mass effect or enhancement, most consistent with remote microvascular ischemic change present to mild degree. Bilateral intracavernous carotid and vertebral arteriosclerotic calcification. Probable anterior communicating artery aneurysm 6 x 5 mm. Recommend intracranial CT angiography to further characterize.

CONCLUSION: 1. No finding suggestive of metastatic disease. 2. Probable 6 x 5 mm anterior communicating artery aneurysm. Recommend intracranial CT angiography to further characterize. 3. Cerebrovascular arteriosclerosis. 4. Calcification left basal ganglia, likely benign; however, recommend continued imaging follow-up.

Reading Radiologist—R. Hercules, MD (non-staff radiologist)

Report Date Time—06/28/20xx 1407

Dr. Hercules listed on the final report has reviewed the image and has agreed with or edited the report.

Electronically signed by: R. Hercules, MD

Radiology Fee Ticket

Patient NameT. Greenwald
Medical Record Number/Account Number4589700
RadiologistR. Hercules, MD
Referring PhysicianP. Ford, MD
Insurance CompanyUnited Healthcare
Date of SurgeryFacilityPlace of serviceCPT CodeDiagnosis Code(s)ModifierQuantity
06/28/20XXXYZ Outpatient Center2270470C34.90, I67.2, G23.8261$175.00



What information is not correct to validate the service provided?
A. All information reported validates the service provided.
B. Place of service
C. Modifier
D. ICD-10-CM codes