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Thread: coding secondary/metastatic CA

  1. #1
    Join Date
    Apr 2007
    St. Louis

    Question coding secondary/metastatic CA

    AAPC: Back to School

    As an auditor for a physician group, I have been getting complaints about the coding of secondary cancer(s). I have reviewed a few of the other threads here, stating that if secondary site is coded, primary should be coded as well.

    I used to teach coding & I recall that the primary site--regardless if it is active or not (Hx of)--should ALWAYS be coded along with the secondary. In contrast, under secondary malignancies in the ICD-9, there are no annotations stating that primary site need be coded. Any truth to my recollection? Or to the contrary?

    Is there any deeming oncology authority/expert/website that I can use as a frame of reference for my physicians?

    Last edited by arcosas; 04-16-2010 at 09:07 AM. Reason: wording & clarity

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    AHA coding clinics have always stated that you always code the primary when coding the secondary. And it makes good sense since the secondary is only the primary located in a different organ. Even if the prmary is unknown we list it as 199.1.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default Coding Sequence

    Per the Oncology manual "Coding Strategies", if the treatment is directed at the malignancy , designate the malignancy as the principal diagnosis. If pt. is treated for the secondary site "only", then the the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.

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