Wiki Need input re code choice for leptomeningeal carcinotmatosis

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dtricia

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The patient has lung cancer. The chart note reads metastatic, (cerebellar-198.3) , now new finding confirming leptomeningeal carcinomatois. I am having a little trouble deciding how to code the carcinomatosis.
Specified site NEC -see Neoplasm by site malignant makes this another primary, not a metastasis. It would be192.1, Meninges?
 
If this is truly leptomeningeal carcinomatosis, the proper code would be 199.0 for this and then you would code the primary carcinoma from where the metastasis began.

Hope this helps
 
Leptomeningeal carcinomatois

why do you suggest this code 199.0 for unspecified site if a site is specified -in the meninges ? I can look up leptomeninges and see that it is the pia mater.
I am also trying to understand why the code book instruction is for another primary code. It seems like it would be a metastasis.
Tricia D
 
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dtricia said:
The patient has lung cancer. The chart note reads metastatic, (cerebellar-198.3) , now new finding confirming leptomeningeal carcinomatois. I am having a little trouble deciding how to code the carcinomatosis.
Specified site NEC -see Neoplasm by site malignant makes this another primary, not a metastasis. It would be192.1, Meninges?
Click to expand...

198.4 (2ndary malignant neoplasm; Other parts of nervous system; Meninges [cerebral, spinal])
 
198.4

I like the code, but how did you get there from the code descriptor? I nned a path to explain this to the provider and I cannot see it.
thanks for your help
Tricia D
 
Your chart note is vague and badly written. I read it as the patient has primary lung with mets to the brain then there is a comma and it states now a new finding confirming Leptomeningeal carcinomatosis. Leptomeningeal carcinomatosis refers to diffuse seeding of the leptomeninges by tumor metastases it is a rare complication of cancer in which the disease spreads to the membranes (meninges) surrounding the brain and spinal cord, so they have mets to the cerebellum, plus mets to the meninges.
 
Code book path

I am referring to a code book path. If you use a code book, like I do, and you look up carcinomatosis, you do not get to 198.4 with this verbage.
Patient did have cerebellar mets to brain 198.3 with new finding of leptomeningeal carcinomatosis.
I did not write the note.
 
the term carcinomatosis by itself would indicated widely disseminated metastatic cancer, as one physician told me once it means they have cancer everwhere. however this is specifically in the leptomeningeal area meaning it is widely disseminated within that area, so you would go to the neoplasm table and find meninges and follow that to the secondary colum for your code path.
 
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leptomeningeal carcinotmatosis

Thank you for your time and clarifying. I guess not all codes follow the rules.
Tricia
 
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