Squamous cell carcinoma

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Good morning,

Can anyone help with coding for SCC...the provider stated Metastatic left neck SCC. When I look under the table of neoplasms in the code book and go to neck, squamous cell it only gives code for primary cancer (C44.42), nothing is listed under secondary. I am unable to query the provider and I want to get any opinions on if I am coding this correctly.
 

trarut

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I work in Oncology. This phrasing - Metastatic left neck SCC - says to me that the neck is the primary site and the metastases are elsewhere (although they could also be in another area of the neck). If you can't query your provider, you need to review the diagnostic tests and pathology that the physician reviewed to get clarification of the actual sites of disease before you attempt to assign a code. It could be that the mets are in the neck and it's the way the physician has phrased it - but you need to know for sure before assigning a code that becomes part of the patient's permanent record.

For the record though - secondary sites are not usually coded by the type of cancer, simply to the site of disease. If the primary is SCC, it's a given the secondary site is SCC. If it's not, it's not metastatic disease, it's a new primary cancer. There are exceptions, such as carcinoids and neuroendocrine tumors, because there are always exceptions.
 
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Thank you for your response, I reviewed the chart and the Cytology report reads as follows: Squamous cell carcinoma, nonkeratinizing. The diagnosis is supported by positive CK5/6 and p40 immunostatins. I reviewed the last office note after that report and it states Metastatic SCC lymph node in left neck- origin unknown at this time. To me, that says it's secondary but I am definitely not an expert when it comes to Oncology coding. Any thoughts?
 

trarut

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You are correct - THAT phrasing in the last office note supports that it's a secondary site but it doesn't help with the current note since the notes & related diagnosis codes must stand alone, just as they do for any other specialty.

Does the cytology report state it's a metastatic site? It is generally accepted as OK to get clarification of diagnosis from the pathology report if the physician is not available to clarify. If not, I would code what is stated in the current note - a primary neck malignancy. You only code what you know, otherwise you're diagnosing the patient and you can't do that.

Edited after rethinking the response.
 
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danachock

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Say, I was thinking about this last night after reviewing your discussion. I have a question and since I don't have the pathology report to review the gross or microscopic description - it has me wondering if this is lymphoid tissue we are dealing with? If so it would be appropriate to bill C77.0 for the mets.
warrenfamily103@gmail.com are you able to offer any additional details on the gross or microscopic findings from the pathology report please?
Thank you in advance for all your help,
Dana
 

trarut

True Blue
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Say, I was thinking about this last night after reviewing your discussion. I have a question and since I don't have the pathology report to review the gross or microscopic description - it has me wondering if this is lymphoid tissue we are dealing with? If so it would be appropriate to bill C77.0 for the mets.
warrenfamily103@gmail.com are you able to offer any additional details on the gross or microscopic findings from the pathology report please?
Thank you in advance for all your help,
Dana
Valid question. I think the path report would indicate that and not call it SCC but am interested if the OP can provide more details.
 
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