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Thread: B Jernigan

  1. #1

    Default B Jernigan

    AAPC: Back to School
    My doctors are having the discussion of how to code cancer that has metastasis from one site to another. Some of the information they have is that secondary cancer is a diferent cancer from the primary cancer, ex: caused from radiation. But in my ICD 9 book, the only choices I have in the neoplasm index is primary, secondary and in situ
    for malignant cancer. My question is how do you code cancer that has metastasis from the primary site? I have always coded it as secondary. What is correct?

  2. #2
    Join Date
    Apr 2007
    Bangor, Maine


    The link below may be helpful for you....

    Also, below that, the is an article for the Coding Clinic that explains cancer coding really well. If you scroll down a ways, they discuss metatastic coding guidelines.


    Neoplasm coding - guidelines
    ******Coding Clinic, May - June 1985 Page: 9 to 12

    Coding Rules and Guidelines

    Note from 3M:
    These coding guidelines were updated and in some cases superseded by new guidelines published in Coding Clinic, Second Quarter, 1990 .

    Contiguous Sites: A primary malignant neoplasm that overlaps the boundaries of two or more subcategories within a three-digit category and whose point of origin cannot be determined is classified to the fourth-digit subcategory ".8."

    For contiguous sites between three-digit categories, ICD-9-CM provides the following four-digit codes for certain malignant neoplasms whose point of origin cannot be assigned (not established) and whose stated sites overlap two or more three-digit category sites.

    149.8 Neoplasms of lip, oral cavity, and pharynx whose point of origin cannot be assigned to any one of the categories 140-148

    159.8 Neoplasms of digestive organs and peritoneum whose point of origin cannot be assigned to any one of the categories 150-158

    165.8 Neoplasms of respiratory and intrathoracic organs whose point of origin cannot be assigned to any one of the categories 160-164

    Vague Sites: Malignant neoplasms of contiguous sites (overlapping boundaries), not elsewhere classified, whose point of origin cannot be determined are assigned to 195, Malignant neoplasm of other and ill-defined sites. Inclusion terms under category 195 at the fourth-digit level are the following:

    195.0 Head, face, and neck, such as cheek, jaw, nose, cervical region, supraclavicular region

    195.1 Thorax, such as axilla, chest, chest wall, intrathoracic site, thoracic wall, infraclavicular region, scapular region

    195.2 Abdomen, such as abdominal wall, intra-abdominal nonspecific site

    195.3 Pelvis, such as buttock, groin, ischiorectal fossa, pelvic wall, perineum, rectovaginal septum, rectovesical septum, gluteal region, inguinal region, perirectal region, presacral region, sacrococcygeal region

    195.4 Upper limb, such as antecubital space, arm, elbow, finger, forearms, hand, shoulder, thumb, wrist

    195.5 lower limb, such as ankle, calf, foot, heel, hip, knee, leg, popliteal space, thigh, toe

    195.8 Other and ill-defined sites, such as back, flank, trunk

    Lymph Nodes or Glands: Malignant neoplasms of lymph nodes or glands are presumed to be secondary neoplasms (196.0-196.9) unless the diagnosis states or indicates a malignancy classifiable to categories 200-202. Lymphoma(s) may be benign or malignant. If the physician's diagnostic statement does not match any subentries under Lymphoma on page 460 in the Alphabetic Index, refer to the pathology report for correlation with entries on page 460 in the Alphabetic Index. Otherwise, ask the responsible physician if the lymphoma is benign or malignant.

    Liver: If unspecified in the diagnosis, malignant neoplasms of the liver are not presumed to be either primary or secondary in nature. In such cases, a separate code, 155.2, has been provided for malignancy of liver not specified as primary or secondary.

    Recurrence of Primary Malignancy: If the primary malignant neoplasm previously excised or eradicated has recurred, code it as primary malignancy of the stated site, using the appropriate code in the 140-195 series. Code also any mention of secondary site(s). Recurrence of previously excised anterior wall bladder carcinoma, now identified as lateral wall, 188.2, is an example. Another example is recurrence of carcinoma of the ascending colon at the site of previous anastomosis with rectum, 154.0.

    No Recurrence at Primary Malignancy Site: If the primary site of the malignancy as previously excised or eradicated by treatment and the original primary site has not recurred and is no longer under treatment, code the previous primary site as "personal (past) history of malignant neoplasm," using the appropriate subcategory code under V10. Code any mention of current secondary sites.

    If the patient is still under active treatment for malignancy of primary site, either radiation or chemotherapy, retain the code for malignancy of primary site. The patient would not be receiving radiation therapy or chemotherapy directed at the primary site unless further treatment were needed.

    Follow-up Examination for Any Malignancy Recurrence: Periodic follow-up examinations are carried out to determine if there is any recurrence of primary malignant neoplasm site or any occurrence of secondary malignant neoplasm site(s). If there is evidence of recurrence at the primary site, code it as primary of stated site. If there is evidence of a secondary (metastasis) site, code it to the stated secondary malignancy site. If there is no evidence of any recurrence or metastatic site, use the appropriate code from the V67.0-V67.2 series as the principal diagnosis. Select from the V67.0-V67.2 series the last previously carried out therapy for the principal diagnosis. Select the appropriate code from the V10 category, personal history of malignant neoplasm, as the secondary code. Code also the procedures carried out in the follow-up examination, such as an endoscopy, biopsy, and so forth.

    Metastatic Site as Principal Diagnosis: If only one site is stated in the diagnosis and that site is qualified as "metastatic" and the body of the medical record provides no further information to assist in coding the diagnosis, the following steps must be taken:

    1. Code to the category for "primary of unspecified site" for the morphology type stated in the diagnosis, such as:

    Metastatic infiltrating duct carcinoma, 174.9
    Metastatic islet cell adenocarcinoma, 157.4
    Metastatic endometrial sarcoma, 182.0
    Metastatic malignant histiocytoma, 171.9

    However, if the code thus obtained is 199.0 or 199.1 (such as metastatic carcinoma, colon, 199.1), follow the instructions in step 2.

    2. If the morphology is not stated or the code obtained in step 1 is 199.0 or 199.1, assign the site qualified as "metastatic" to the primary malignant code for that stated site (such as, metastatic carcinoma of colon, 153.9) except for the following sites, which should be coded as secondary neoplasm of the stated site:

    Lymph nodes
    Spinal cord
    Sites classifiable to 195.0-195.8

    3. Steps 1 and 2 should result in code assignments for both primary and secondary sites of specified sites or one site specified and one site unspecified.


    Metastatic renal cell carcinoma of lung is coded following step 1:

    Carcinoma, renal cell type 189.0
    Metastasis to lung, 197.0

    Metastatic carcinoma of lung, 199.1, is coded following step 2:

    Primary site is assigned to lung, 162.9
    Secondary site is assigned 199.1

    4. Cancer described as "metastatic from _______ (site)" should be interpreted as primary of that site.


    Metastatic carcinoma from breast is coded 174.9, and code 199.1 is used to indicate metastatic site unspecified.

    5. Cancer described as "metastatic to _______ (site)" should be interpreted as secondary neoplasm of the stated site.


    Metastatic carcinoma to lung is coded 197.0 with code 199.1 to indicate primary site not specified.

    6. If two or more sites are stated in the diagnosis and all are qualified as "metastatic sites," code the primary site as "unknown" (199.0) or where appropriate "ill-defined site" (195.0--195.8), and code the stated sites as secondary neoplasms of those sites.


    · Metastatic carcinoma of stomach and left lower lung is coded as secondary malignancy of stomach, 197.8; secondary malignancy of lung, 197.0; and primary malignancy of unknown site, 199.1.

    · Metastatic carcinoma of colon and liver with pelvic malignancy is coded as secondary neoplasm of the colon, 197.5; and of the liver, 197.7; with mention of pelvic malignancy, 195.3.

    Diagnostic Statement of Malignancy versus Pathology Report of No Malignancy:Patient is admitted to the hospital following a biopsy performed as an outpatient, and the pathology report on that biopsy identifies a malignant neoplasm. Surgery is performed in the hospital to remove further tissue or to partially or totally remove an organ. The pathology report is negative for any further evidence of malignancy. The physician documents the diagnosis as a malignancy in accordance with the findings on the original biopsy report. Code the malignancy as recorded by the physician and make sure the biopsy report from the outpatient procedure documenting the malignancy is on file with the current medical record. Certain types of malignant neoplasms, noted for their invasiveness, may require further excision due to the probability of microinvasiveness. Biopsy findings of malignancy, such as melanoma of the skin or carcinoma of the cervix, colon, breast, or prostate may require more extensive surgery.

    ©*Copyright 1984-2010, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.

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