Updated on: September 23, 2013

ICD-10-CM Neoplasm Codes

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Original story posted on: March 16, 2012

The neoplasm chapter in ICD-10-CM has undergone some significant changes. Just as in ICD-9-CM, neoplasms are classified primarily by site and behavior (benign, carcinoma in-situ, malignant, uncertain behavior and unspecified). However, in ICD-10-CM there are additional classifications that are now grouped by morphology (histologic type). Therefore, selecting the most specific code for some neoplasms will require documentation of the histologic type of the neoplasm.

General Guidelines for Neoplasm Coding

To assign the most specific code possible, documentation must be reviewed to determine the histologic behavior. Malignant neoplasms must be further differentiated as primary or secondary. Records containing evidence of a primary malignant neoplasm also should be reviewed for documentation of any secondary or metastatic sites.

The Alphabetic Index and Table of Neoplasms should be referenced as follows:

  • If the histological type is documented, that term is referenced first to identify the histological behavior as benign, malignant or uncertain. The neoplasm table then is used to identify the correct category, subcategory or code, and the tabular list is referenced for any additional coding instructions.
  • If a specific code is listed in the alphabetic Index for the histological type, the neoplasm table is not referenced. The tabular list is reviewed for any additional coding instructions. For example, a liver lesion identified on the pathology report as a hepatoblastoma has a specific code listed in the alphabetic index, C22.2 Hepatoblastoma, so the neoplasm table does not need to be referenced.
  • If the histological type is not referenced but the histological behavior (benign, malignant, uncertain, etc.) is documented, the neoplasm table is consulted to identify the correct code and the tabular list then is reviewed for any additional coding instructions.

Documentation Checklist for Assigning Neoplasm Codes for Solid Organ/Tissue Neoplasms

There are a number of solid organ/tissue neoplasms that have more specific codes in ICD-10-CM. Codes for some neoplasms are more specific in terms of site and histologic type. The best way to identify what additional documentation will be required is to develop checklists related to the additional information captured by ICD-10-CM codes. A general checklist for coding neoplasms might look something like the one below.

Identify the following for solid organ/tissue neoplasms:

  • Site
  • Histologic behavior
    • Benign
    • In situ
    • Malignant
      • Primary site
      • Secondary (metastatic) site(s)
    • Uncertain behavior
    • Unspecified

 


 

  • Histologic type for some organs/tissues
    • Malignant neoplasms
      • Liver and intrahepatic bile ducts
        • Liver cell carcinoma (hepatocellular carcinoma, hepatoma)
        • Intrahepatic bile duct (cholangiocarcinoma)
        • Hepatoblastoma
        • Angiosarcoma (Kupffer cell sarcoma)
        • Other specific liver sarcomas
        • Other specified liver carcinomas
        • Unspecified type, primary malignancy of liver
        • Unspecified type, liver, not specified as primary or secondary
      • Skin
        • Malignant melanoma
        • Basal cell carcinoma
        • Squamous cell carcinoma
        • Other specified histologic type
        • Unspecified
      • Mesothelial and soft tissue
        • Mesothelioma
        • Kaposi’s sarcoma
        • Merkel cell carcinoma
      • Neuroendocrine tumors
        • Malignant carcinoid tumor (primary)
        • Secondary carcinoid tumors
    • In situ neoplasms
      • Skin
        • Melanoma in situ
        • Carcinoma in situ
    • Benign neoplasms
      • Skin
        • Melanocytic nevi (atypical nevus, blue hairy pigmented nevus, nevus NOS)
        • Other benign neoplasms
      • Uterus
        • Leiomyoma
        • Other benign neoplasm
      • Neuroendocrine
        • Benign carcinoid tumor
        • Other benign tumor
  • Laterality, for paired organs or extremities
  • Sex, for neoplasms of the breast

 

Summary

This is just a brief overview of a few of the more specific designations for neoplasms. It will be necessary to perform a more thorough review of the neoplasm chapter to identify all categories that will require more specific documentation.

About the Author

Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

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