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Pathology diagnosis

  1. #1
    Question Pathology diagnosis
    Medical Coding Books
    Does anyone have any ideas on which diagnosis code(s) I could assign for this?
    According to the Pathology Report, the pathology on the chest wall lesion specimen is described as "Infiltrating poorly differentiated carcinoma consistent with infiltrating mammary carcinoma"
    Thank you in advance for your help.
    ~Lisa Lott, CPC

  2. #2
    Default jmw
    174.9

  3. #3
    Question
    Quote Originally Posted by TaylorsMom View Post
    Does anyone have any ideas on which diagnosis code(s) I could assign for this?
    According to the Pathology Report, the pathology on the chest wall lesion specimen is described as "Infiltrating poorly differentiated carcinoma consistent with infiltrating mammary carcinoma"
    Thank you in advance for your help.
    ~Lisa Lott, CPC
    It sounds like a malignant neoplasm of the breast, but I'm not certain if it would be considered primary, secondary, ca in situ, or even uncertain behavior:

    I don't know much about this, but, from what I've read, 'infiltrating' = 'invasive', which to me, almost sounds like metastasis, but I'm totally guessing on that.

    According to wiki: "Grade 3, or poorly differentiated: there is very little resemblance between the malignant tissue and the normal parent tissue, abnormalities are evident, and the more complex architectural features are usually rudimentary or primitive" http://en.wikipedia.org/wiki/Carcinomas
    That almost sounds like 'uncertain behavior'...but, when the whole translation, is all put together, (if my web-research has led me to the right conclusions), it could be read as, "Invasive malignant neoplasm of uncertain behavior of chest wall, consistent with invasive neoplasm of breast."

    The codes that are relevant to that are:
    Chest wall neoplasms: primary (195.1), Secondary (198.89), Ca in situ (234.8), Uncertain behavior (238.8), and Unspecified (239.89)
    or
    Breast neoplasms: primary (174.9), Secondary (198.81), Ca in situ (233.0), Uncertain behavior (238.3), and Unspecified (239.3)

    I don't even know if I'm close, or not, though...I'd like to find out the answer, too!
    Last edited by btadlock1; 02-02-2012 at 10:48 AM.

  4. #4
    Default
    Quote Originally Posted by jmwallen View Post
    174.9
    How do you know it's primary?
    I'm not saying you're wrong...I don't know the answer, so I'm trying to learn something new...

  5. #5
    Location
    Fayetteville, NC
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    Default
    I'm honestly leaning toward 198.89 because it sounds to me as if the actual specimen in this case is breast cancer that has metastasized to the chest wall.
    The specimen did not come from the breast therefore, in my opinion, the result can not be breast cancer. It would have to be coded back to the siteit was taken from, which is the chest wall, and from the pathology report stating that the specimen is consistent with infiltrating mammary carcinoma that makes the case for using the secondary malignant code.
    Of course first I would query my doc to see if that fit with his understanding of the pathology report.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  6. #6
    Default
    Quote Originally Posted by btadlock1 View Post
    It sounds like a malignant neoplasm of the breast, but I'm not certain if it would be considered primary, secondary, ca in situ, or even uncertain behavior:

    I don't know much about this, but, from what I've read, 'infiltrating' = 'invasive', which to me, almost sounds like metastasis, but I'm totally guessing on that.

    According to wiki: "Grade 3, or poorly differentiated: there is very little resemblance between the malignant tissue and the normal parent tissue, abnormalities are evident, and the more complex architectural features are usually rudimentary or primitive" http://en.wikipedia.org/wiki/Carcinomas
    That almost sounds like 'uncertain behavior'...but, when the whole translation, is all put together, (if my web-research has led me to the right conclusions), it could be read as, "Invasive malignant neoplasm of uncertain behavior of chest wall, consistent with invasive neoplasm of breast."

    The codes that are relevant to that are:
    Chest wall neoplasms: primary (195.1), Secondary (198.89), Ca in situ (234.8), Uncertain behavior (238.8), and Unspecified (239.89)
    or
    Breast neoplasms: primary (174.9), Secondary (198.81), Ca in situ (233.0), Uncertain behavior (238.3), and Unspecified (239.3)

    I don't even know if I'm close, or not, though...I'd like to find out the answer, too!
    Brandi,
    From what the nurse told me, this patient had breast cancer. She had a mastectomy. A lesion later appeared on her chest wall, where her left breast was. Another dilemma I had was trying to decide if this would be considered cancer of the breast or chest wall?
    I'll keep looking for the answer! Thanks for your input!
    ~Lisa Lott, CPC

  7. #7
    Question Learning opportunity!!!
    After reading in the tabular a little further, my theory has narrowed down a little....I definitely don't think it's ca in situ anymore, and I'm torn between a couple of codes...I'll explain my train of thought - somebody please let me know whether or not my logic's correct:

    First, I remembered that this is a path report for a chest wall lesion, which really makes me want to lean toward 195.1 - Malignant neoplasm of thorax (chest wall) NOS - the 'includes' note under 195 is making me second guess that, though, because it says "malignant neoplasms of contiguous sites, NEC, whose point of origin cannot be determined"

    Here's what's throwing me off:
    1. When I hear the word "invasive", I think "aggressive", but more in the sense that, something is aggressively taking over (invading) something else. That almost aounds like a metastasis, to me; if this chest wall lesion is a metastasis, it would be 198.89; but, I can also see how it might just mean 'aggressive', in general.

    2. 'Poorly differentiated', sounds to me, like the point of origin can't be determined, which contradicts my theory on 'invasive' possibly meaning 'metastasis'; and supports my original thought of 195.1

    3.Also, I'm not sure how much weight to give to the statement "consistent with..." in this situation; normally, I'd say that 'consistent with', symbolizes a certain degree of confidence, that you know what you're dealing with: it's not just a hunch; a probable hunch...

    So, it would almost be like the note could be saying:
    "This chest wall lesion is an aggressive, malignant neoplasm, and we're not sure exactly where it originates from, but it's consistent with an aggressive malignancy of the breast, so we're going to consider it a malignant neoplasm of the breast." (in other words, "this is probably aggressive breast cancer, but we can't tell where it started.")

    But, I could just as easily read the same statement as:
    "This chest wall lesion is an invasive malignant neoplasm (of the chest wall), and it's difficult to tell where it originates from, but it's consistent with being a metastasis (eg, an invasion) of an aggressive malignant neoplasm of the breast." (in other words - "this cancer on the chest wall probably spread from some aggressive breast cancer")

    So I guess my biggest question on this (aside from whether or not I understand what 'invasive' and 'poorly differentiated' mean in context), would be: If the lesion is on the chest wall, and it's cancerous, but resembles breast cancer, are they saying that it is breast cancer, or that it started out that way, and spread to the chest wall?


    Sorry if any of that sounded dumb... (Please be patient with me! )
    I don't get many opportunities to code oncology stuff, so I'm ignorant on the subject...And when I want to learn something, I have to list out all of my logic, so I know where I went wrong in my thinking, if necessary. So...can anyone tell me if my guess is even remotely correct, somewhere?

  8. #8
    Default
    Quote Originally Posted by TaylorsMom View Post
    Brandi,
    From what the nurse told me, this patient had breast cancer. She had a mastectomy. A lesion later appeared on her chest wall, where her left breast was. Another dilemma I had was trying to decide if this would be considered cancer of the breast or chest wall?
    I'll keep looking for the answer! Thanks for your input!
    ~Lisa Lott, CPC
    That helps a LOT...Now, the Chapter-specific guidelines for 'primary malignancy previously excised', apply:
    "When a primary malignancy is excised and there is no further treatment directed to that site," (which there wouldn't be, if the site is no longer there), " a code from V10, personal Hx of malignant neoplasm, is used to indicate the site of the former malignancy. Any mention of extension, invasion, or metastasis (LOL - I guess invasive does = metastasis), to another site, it is coded as a secondary malignant neoplasm to that site."

    So, I'd go with 198.89, V10.3

  9. #9
    Talking
    Quote Originally Posted by btadlock1 View Post
    That helps a LOT...Now, the Chapter-specific guidelines for 'primary malignancy previously excised', apply:
    "When a primary malignancy is excised and there is no further treatment directed to that site," (which there wouldn't be, if the site is no longer there), " a code from V10, personal Hx of malignant neoplasm, is used to indicate the site of the former malignancy. Any mention of extension, invasion, or metastasis (LOL - I guess invasive does = metastasis), to another site, it is coded as a secondary malignant neoplasm to that site."

    So, I'd go with 198.89, V10.3
    Brandi,
    You really did your homework on this one! I really appreciate all of your help and information. I guess we both learned something today.

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