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Help with Path report

dvance4210

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I would appreciate any help with coding this path report

Preop diagnosis: Lytic lesion

Path Report:
Frozen Diagnosis: Nodule attached to left 4th rib

Diagnosis: Benign partially calcified fibrocartilagenous nodule adjacent to rib.


The hospital coded it as M89.9 but I don't feel that's appropriate

Thanks in advance!

D Vance, CPC, CCVTC
 

mitchellde

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I would not use that code with the path report because it is not unspecified. the path says it Is benign so I would use the neoplasm and go to costal cartilage then benign. I think that is a more specific code.
 

thomas7331

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How about M89.8X8, which is more specific than M89.9.

I'm often reluctant to use the neoplasm codes when it's not specified in the pathology report as a neoplastic lesion. Is there any guidance on what conditions can be classified as a neoplasm?
 

mitchellde

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The definition of neoplasm is new growth, so really any anomaly once identified as an anomaly can be considered a new growth, but it takes pathology to determine if it is benign, malignant or uncertain. So the path report says it is benign then I code to the pathology that it is benign as that is more specific than saying it is a disorder.
 

bbooks

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I agree with thomas7331. We shouldn't use a neoplasm code unless the lesion has been confirmed by the pathologist to be neoplastic and benign. AFP's "Pathology Service Coding Handbook" discusses this at length. I will post some more info tomorrow.
 
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bbooks

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Sorry for the delay and for the confusion as to whom I was referring.

On page 37 of APF's "Pathology Service Coding Handbook" for Jan. 2019, the definition of "neoplasm" is discussed. Two definitions are provided:

“any new and abnormal growth…of tissue in which the growth is
uncontrolled and progressive.” [Dorland’s Illustrated Medical Dictionary, 30th edition]​


“an abnormal mass of tissue, the growth of which
exceeds and is uncoordinated with that of the normal tissues and persists in the same
excessive manner after cessation of the stimuli which evoked the change.” [Robbins, Cotran
and Kumar, Pathologic Basis of Disease, 3rd edition, pg. 214]​

The key things here for "neoplasm" are the characteristics of "uncontrolled," "progressive," and "persists." Not all new growths are considered "neoplastic."

On page 52, in the section "Myths and Misconceptions in Pathology ICD Coding" is "Report normal tissue with a benign neoplasm code." "Pathologists often use the adjective 'benign' to mean 'normal'... So, there is a difference between "benign tissue" and "benign neoplastic tissue." If the pathologist gives no indication that the tissue is neoplastic, then a neoplasm code is not appropriate.

I am curious about what the microscopic says. The diagnosis is "Benign partially calcified fibrocartilagenous nodule adjacent to rib" which, to me, sounds like a disorder of the cartilage next to the rib, not a disorder of the bone itself (M89.9). In the absence of the microscopic, I would code this as a disorder of the cartilage, M94.8X8.
 
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mitchellde

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I disagree, when a pathologist renders a diagnosis of benign they do not need to state neoplasm also, I would codes this as a benign neoplasm and not a disorder since the disorder has been identified by pathology.
 

bbooks

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I agree that they typically don't use the actual word "neoplasm." Look for these words: adenoma, papilloma, carcinoma, adenocarcinoma, leukemia, melanoma,
cystadenoma, sarcoma or lymphoma. I worked with dermatopathologists who instructed me to use a neoplasm code when they used the term "proliferative."

I'll see if I can find and online article that covers this more completely.
 

danachock

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Sharing findings ~ Help with Path Report

Hi,

Take a moment pleaase ~ I have my opinion to offer on this; this is not a neoplastic process. It is benign (like many pathology charges I have ever had to code) - to put it simply ~ there is nothing is wrong. I will provide documentation from my several years being with the AAPC on this finding unless someone wants to provide documentation to state otherwise and it has to be documented from the AAPC, just as I will provide from the AAPC resource I have. Like I stated it shouldn't matter if it's ICD-9 or ICD-10, the principles should remain the same.

Reference:
Study Guide for CHONC
Hematology & Oncology
Comprehensive study guide for specialty certification with review of ICD-9-CM, CPT, and HCPCS Level II coding concepts and guidelines
Dated 2013

(This is the actual study guide I purchased with my seat to sit for this certification). This is a book the AAPC sent me when I was studying to pass this CHONC certification. I will provide page 10 & page 11 information/explanation. Lower right hand corner heading on page 10 that flows to upper left hand on page 11.
> If anyone simply questions this; I would be happy to take a photo of the book along with page 10 & 11 for reference and send it to you.

This is the heading from lower right corner of Page 10:

Proper Use of the Neoplasm Table
The improper use of the neoplasm table is a widespread error, especially among more seasoned coders. The first step in any lookup should be to go the index. The neoplasm table is a tool used if the index refers to it. The index will keep a coder from making wrong assumptions about the column in the neoplasm table to use and wrong assumptions even more basic - about whether the code can be found in the table.

There are six columns in the Neoplasm table, each representing growths that are malignant, benign, secondary, in situ, unspecified, or of uncertain behavior. There are many types of neoplasms that are not addressed at all in the table. A fatty tumor, or lipoma, is not represented in the table. Melanomas aren't there. Primary and secondary Merkel cell carcinomas aren't there. Carcinoid and other neuroendocrine tumors aren't there. Many polyps aren't there. It is important to check the index before going to the Neoplasm table.

The first step is to look up the key term in the index. From there, a coder will be referred to tables or to the tabular section. If referred to the tables, verify the code in the tabular section. If a physician documents basal cell carcinoma, most coders understand that this is malignant neoplasm. The same care must be be taken regarding the documentation describing the diagnosis. Here, we reiterate the note from the beginning of the neoplasm table: an adenoma is benign, according to the index but if the physician says "malignant" adenoma, his words trump the index and a malignant neoplasm would be coded.

I am a book coder (nearly 7 years). I have my 2019 ICD-10-CM Expert for Physicians book and there is no reference to the neoplasm table when referring to:
1) fibrocartilagenous
2) calcified
3) nodule

Would or could someone please explain to me simply how do we get to the neoplasm table without the index referring to the instructions provided from my AAPC manual? We simply do not go to the neoplasm table without the index telling us as a coder(s) to go to the Neoplasm table per instructions provided by the AAPC.

Thanks for listening to my opinion this evening,

Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
 
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