Updated on: November 21, 2016

ICD-10: Coding Brain Cancer

Original story posted on: June 8, 2015

EDITOR'S NOTE: Kathy Pride is continuing her reporting on diseases that have been covered in the national news media as they relate to ICD-10.The death of Beau Biden, the late son of Vice President Joe Biden, prompted this article.

In the news this week was a sad occurrence: Beau Biden, son of Vice President Joe Biden, died after a tough battle with brain cancer. He was just 46 years old. According to the National Cancer Institute, brain cancer represents only 1.4 percent of all new cancer cases in the United States. Brain tumors occur in both children and adults. After leukemia, brain cancer is the second most common form of cancer diagnosed in childhood. However, over 50 percent of the people diagnosed with brain cancer between 2008 and 2012 were between the ages of 45-74.

Brain tumors occur when cells in the brain grow abnormally, creating what are known as primary brain tumors, or when cancers from other parts of the body spread to the brain, known as metastatic brain tumors. Not all brain tumors are cancerous; however, a benign tumor can still cause many problems by putting pressure on surrounding tissue in the brain.

Like any type of cancer, survival rate is often dependent upon early detection. Fortunately, the five-year survival rate for brain cancer has increased from almost 23 percentin 1975 to over 35 percent in 2007.

Symptoms of brain tumors include:

  • Headaches that may be severe or worsen with activity
  • Seizures
  • Personality or memory changes
  • Nausea or vomiting
  • Fatigue

Paying attention to signs and symptoms is even more important if you have already been diagnosed with cancer, even if you are currently cancer-free. Just because you had treatment doesn't cancel out your need to have regular follow-up visits to ensure that the cancer hasn't spread to other parts of your body, including your brain.

As in ICD-9-CM, coding for brain cancer in ICD-10-CM requires documentation of the specific anatomical location within the brain. There are only a few small differences between the two coding systems in this area. ICD-10-CM added "cerebral ventricle," and there is no catch-all code in ICD-10-CM for "other location of the brain."

The following anatomical locations are listed within category C71 - Malignant neoplasm of the brain:

  • C71.0 Malignant Neoplasm of cerebrum, except lobes and ventricles
  • C71.1 Malignant Neoplasm of frontal lobe
  • C71.2 Malignant Neoplasm of temporal lobe
  • C71.3 Malignant Neoplasm of parietal lobe
  • C71.4 Malignant Neoplasm of occipital lobe
  • C71.5 Malignant Neoplasm of cerebral ventricle (new in ICD-10-CM)
  • C71.6 Malignant Neoplasm of cerebellum
  • C71.7 Malignant Neoplasm of brain stem
  • C71.8 Malignant Neoplasm of overlapping sites
  • C71.9 Malignant Neoplasm of, unspecified

Secondary (metastatic) brain cancer is coded as C79.31. There are three codes for benign brain tumors:

  • D33.0 Benign neoplasm of brain, supratentorial
  • D33.1 Benign neoplasm of brain, infratentorial
  • D33.2 Benign neoplasm of brain, unspecified

Other codes for brain tumors include:

  • D43.0 Neoplasm of uncertain behavior of brain, supratentorial*
  • D43.1 Neoplasm of uncertain behavior of brain, infratentorial*
  • D43.2 Neoplasm of uncertain behavior of brain, unspecified*
  • D49.6 Neoplasm of unspecified behavior of brain

*Note – Uncertain behavior does not mean "not documented." Uncertain behavior is a specific pathologic diagnosis indicating behavior that cannot be predicted, as opposed to a diagnosis of unknown pathology. A neoplasm of unknown pathology should be coded as unspecified.

To assign the most specific code, documentation must be reviewed to determine the histology of the neoplasm as malignant, benign, in-situ, or uncertain behavior, as well as the specific anatomical location of the neoplasm. The neoplasm table is used to identify the correct category, subcategory, or code, and the tabular list is referenced for any additional guidelines and/or coding instructions. The neoplasm table is no longer located in the alphabetic index under the "Ns". The table is now located after the alphabetic index and before the table of drugs.

The alphabetic index also may be used to locate the proper code by histology type. For example, when you look up glioblastoma for a specified site, the alphabetic index refers you to neoplasm, malignant, by site. Referencing the neoplasm table first often can eliminate the need for this step; however, if you are unsure of the histology, the index will lead you to the correct histology. In the case of a glioblastoma, the index refers you to malignant neoplasm by site.

When learning the new coding system, it is very important to read the ICD-10-CM guidelines. These guidelines can be found at the beginning of your ICD-10-CM book or downloaded from the Centers for Medicare & Medicare Services (CMS) website at http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html.

The ICD-10-CM Guidelines, Section I.C.2, has several differences from the ICD-9-CM Guidelines, Section I.C.2. The guidelines contain important information regarding coding and sequencing the neoplasm codes, and this applies to the entire neoplasm chapter. One significant change in the guidelines from ICD-9 to ICD-10 is the sequencing of anemia associated with malignancy, chemotherapy, immunotherapy, and radiation therapy.

Our new guidelines tell us when the admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the malignancy code is sequenced as the principal or first-listed diagnosis, followed by the appropriate anemia code (such as code D63.0, Anemia in neoplastic disease).

However, when the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy and/or immunotherapy (or an adverse effect of radiotherapy) and the only treatment is for the anemia, the anemia code is sequenced first. This is followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5, Adverse effect of antineoplastic and immunosuppressive drugs) or code Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient – or of later complication, without mention of misadventure at the time of the procedure.

The guidelines also instruct us that when a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site (and no evidence of any existing primary malignancy), a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed, with the Z85 code used as a secondary code. The appropriate code for personal history of brain cancer is Z85.841.

Although there are some genetic conditions and environmental factors that are thought to contribute to the development of brain cancer, the risk factors are much less defined than for other cancers in the body. The upside to this story is that brain cancer is the most rare of all cancers, and the American Cancer Society estimates the risk over a lifetime is less than 1 percent.

About the Author

Kathy Pride, CPC, RHIT, CCS-P, is vice president of coding and documentation services for Panacea Healthcare Solutions. Kathy has extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits and education. She is also an approved ICD-10 Trainer through the American Health Information Management Association (AHIMA) and a previous member of the AAPC National Advisory Board (1998 – 2000).

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Kathy Pride, RHIT, CPC, CCS-P, CPMA

Kathy is a proven leader in healthcare revenue cycle management with extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits, and education. She has trained and managed Health Information Management (HIM) professionals in multiple environments. She is currently the Senior Vice President of Coding and Documentation Services for Panacea Healthcare Solutions. Kathy has provided compliance auditing and documentation education to hundreds of physicians and coders throughout her career.

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