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Conquer Neoplasm Coding Challenges

Arlynn Hansell, PT, HCS-D, HCS-H, HCS-O, COS-COwnerTherapy and More, LLCCincinnati, OH

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Learning Objectives

At the completion of this course, the learner will be able to:

1. Explore the neoplasm guidelines and sequencing issues which are key to the correct coding of neoplasms and their related complications.

2. Learn when you need to look up terms in the Alpha Index first vs. going directly to the Neoplasm table

3. When to code the primary cancer vs. history

4. When it’s appropriate to use symptom codes such as fatigue and dehydration.

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What is a neoplasm?

• “Neoplasm” is an abnormal mass of tissue that results when cells divide more than they should or do not die when they should, which can be either malignant (cancerous), or benign, (not cancerous).

– The terms tumor, fibroid, adenoma, myoma, and sarcoma indicate a neoplasm.

• A tumor is an abnormal mass of tissue, which may be solid or fluid-filled. A tumor does not automatically mean cancer.

• Tumors can be:

– benign (not cancerous)

– pre-malignant (pre-cancerous)

– malignant (cancerous).

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Some General Facts

• Chapter 2, ranging from C00 (Malignant neoplasm of lip) to D49 (Neoplasms of unspecified behavior), contains the codes for most benign and all malignant neoplasms.

• “C” codes: malignant neoplasms

• “D” codes:

– in situ neoplasms

– benign neoplasms

– those of uncertain behavior

– those of unspecified behavior

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Types of Neoplasms

• In order to find the right neoplasm code, you must know the neoplasm’s behavior and what part(s) of the body it is affecting. Do not assume that a neoplasm is always active, malignant cancer.

• Neoplasm Definitions

– Malignant neoplasm is cancerous, grows uncontrollably, and may invade healthy surrounding tissues or spread (metastasize) from the point of origin.

– Primary malignancy is the area where the tumor first developed in the body.

– Secondary malignancy (metastasis) is an area of the body to where the first-listed (primary) cancer has metastasized or spread.

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Metastasis

By Mikael Häggström - All imaged used are in the Public Domain, CC0, https://commons.wikimedia.org/w/index.php?curid=15275048

Cancers are named based on their primary site, regardless of where in the body they spread. For example, a lung cancer that spreads to the liver is still classified as lung cancer and not as liver cancer.

https://www.cancer.org/cancer/cancer-unknown-primary/about/cancer-of-unknown-primary.html

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Types of Neoplasms (cont.)

Benign neoplasm is an abnormal growth but is not cancer and does notinvade surrounding tissues or metastasize to other sites in the body.

BUT: the neoplasm may grow to such a size that it impinges on other organs or structures thereby causing damage or death to those organs/structures. Best example: benign brain tumor.

Carcinoma in situ (CIS or ca in situ), is a group of abnormal cells that are found only in the place where they first formed in the body. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 (zero) disease.

Other terms include: noninfiltrating, noninvasive, preinvasive, and intraepithelial.

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Types of Neoplasms (cont.)

Uncertain behavior describes a neoplasm that is exhibiting characteristics of bothmalignant and benign neoplasms, requiring further study to determine the type. This must be stated by the physician.

Unspecified behavior describes a neoplasm where there is not enough information to select the type. This may occur when the physician is waiting for the pathology report to make a determination of the type of neoplasm, or if the patient refuses diagnostic work-up and the physician hasn’t specified if it is benign or malignant.

• Do not code unspecified behavior just because it is unknown whether a cancer is primary or secondary.

• Codes for these neoplasms should rarely, if ever, be assigned. Query the physician for more information first.

Codes may be assigned for diagnoses listed in pathology or lab reports, if:

▪ the results of the reports have been interpreted by a physician, such as a pathologist or radiologist,

▪ and that diagnosis has been agreed to by the physician.

REMINDER

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More Definitions

Primary versus Secondary site• If “metastatic from,” is stated, this refers to the primary site.

• A secondary site is metastatic from a primary site. If the medical record states “metastatic to,” this refers to the secondary site.

“Primary” diagnosis coding versus Secondary diagnosis coding• For coding purposes, primary refers to M1021a (Principal Diagnosis)

• Secondary coding refers to M1023 b-f (and lower)

• This is NOT the same as primary or secondary site!

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Sequencing Guidelines

• Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site, which may be listed as primary or secondary, depending on the focus of care.

• If there is a primary neoplasm and treatment is directed toward the secondary site, code the secondary site first, even if primary site is still present.

➢ Example: Colon cancer with focus on metastasis to the liver

‒ M1021a: C78.7, Secondary malignant neoplasm of liver

‒ M1023 (b-…): C18.9, Malignant neoplasm of colon, unspecified

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Coding Mass, Lump or Lesion

• Physician documentation of mass, no other information available.

• Look up ‘mass’ in the Alpha Index, search by site.

• Most will land in the R or N chapters

• R: Chapter 18, Symptoms, Signs and Abnormal Clinical and Laboratory Findings

• N: Chapter 14: Diseases of the Genitourinary System

• For unspecified terms, such as mass, lesion, lump, or disease, reference the Alphabetic index.

• Lesion: if there is no index entry of the specified organ or site under Lesion, look up Disease.

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Overlapping Sites and Multiple Neoplasms of Same Site

• If the medical record states “contiguous sites,” this refers to multiple neoplasms with overlapping boundaries, in which the point of origin (primary site) cannot be determined.

– For example, a cancer may involve the cheek and nose.

• A primary malignant neoplasm that overlaps two or more contiguous (overlapping) sites should be classified to the subcategory/code 4th

character of ‘.8’ (‘overlapping lesion’), unless the combination is specifically indexed elsewhere.• E.g.: C34.81, Malignant neoplasm of overlapping sites of right bronchus and lung

• For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the breast, codes for each site should be assigned.

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Primary Malignancy Excised

When a primary malignancy has been excised:

• And further treatment, such as an additional surgery for the malignancy, radiation therapy, or chemotherapy is directed to that site:

• the primary malignancy code should be used until treatment is completed.

➢Code Z48.3, Aftercare following surgery for neoplasm

➢Code neoplasm code

• These can go in either order dependent upon focus of care.

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Primary Malignancy Excised

When a primary malignancy has been previously excised or eradicated from its site:

• There is no further treatment directed to that site, and

• There is no evidence of any existing primary malignancy, and

• The physician has documented that it is eradicated

• a code should be used to indicate the former site of the malignancy (history).

➢Code Z48.3, Aftercare following surgery for neoplasm

➢Code Z85.-, Personal history of malignant neoplasm

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Unknown Site Neoplasm Guidelines

• C80.0, Disseminated malignant neoplasm, unspecified (Carcinomatosis), is used only when the patient has advanced metastatic disease spread diffusely and no known primary or secondary sites are specified/can’t be determined.

(Neoplasm Table Disseminated)

• C80.1, Malignant (primary) neoplasm, unspecified, is used when no determination can be made as to the primary site of the malignancy.

(Neoplasm Table Unknown)

• C79.9, Secondary malignant neoplasm of unspecified site, is used when no site is identified for the secondary neoplasm.

(Neoplasm Table Unknown)

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Symptoms, Signs, and Ill-Defined Conditions Guidelines

• Symptoms and signs listed in Chapter 18 characteristic of, or associated with, an existing primary or secondary site malignancy cannot be used to replace the malignancy as the principal or first-listed diagnosis, regardless of the number of admissions or encounters for treatment and care of the neoplasm.– Symptoms due to the neoplastic disease, such as weakness, fatigue, and

shortness of breath:

• Do NOT assign these in place of, or sequence in priority, over the malignancy.

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Symptoms, Signs, and Ill-Defined Conditions Guidelines

• However, the patient may experience symptoms associated with, but not integral to, the neoplastic disease:– Symptoms such as nausea and vomiting:

• Assign these after the code for the malignancy in sequencing of other codes as appropriate.

• Example:

– Patient admitted to home care for treatment of persistent N&V due to gastric malignancy

• C16.9, Malignant neoplasm of stomach, unspecified

• R11.2, Nausea with vomiting, unspecified (persistent)

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Codes to be careful using….

• Z51.-, Encounter for other aftercare and medical care.

• To be used ONLY if the encounter is solely for the administration of chemotherapy or immunotherapy.

• MUST be assigned in M1021a.

• Caution: This code is only to be used by the provider administering the radiation, chemotherapy, or immunotherapy.

• D49.-, Neoplasms of unspecified behavior

• Includes tumors that have not been defined as malignant or benign.

• “Mass” ≠ uncertain behavior

• Query the physician

• Includes: “growth”, “neoplasm NOS”, “new growth NOS”, “tumor NOS”

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What NOT to code….Per Coding Clinic:

➢ Categories Z40-Z53, Encounters for other specific health care, include a range of specific encounters to indicate that a person not currently ill is encountering the health service for a specific reason (i.e., organ donor, prophylactic care, etc.). Assignment of the appropriate code from these categories, depends on the reason for the encounter or visit.

➢ An encounter for a patient who has already had surgery and is being seen during the healing or recovery phase would be assigned an after care code.

➢ It is not appropriate to assign a code describing an encounter for the initial surgery and an encounter for aftercare for the same visit.

Therefore:

➢ Code Z40.01, Encounter for prophylactic removal of breast, is describing the episode of care for the surgery to remove the breast. Since the home health visit is not the encounter where the breast is actually removed, code Z40.01 would not be assigned for this encounter.

➢ Code Z42.1, Encounter for breast reconstruction following mastectomy, would not be assigned for the home health visit since the breast is not reconstructed during the visit.

X

X

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Prophylactic Organ Removal

➢ A response from the Coding Clinic on 8/17/16 regarding the coding for patients who have opted for prophylactic breast removal for a genetic susceptibility or strong family history states:

Assign an aftercare code for a home health visit during the healing and recovery phase, following the initial treatment (surgery) for removal of the breast.

• The assignment of an additional code under subcategory Z90.1-, Acquired absence of breast and nipple, provides additional information to more fully capture the patient’s condition and reason for aftercare.

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Prophylactic Organ Removal example

➢ Patient with a strong family history of breast cancer and positive genetic testing for susceptibility for breast cancer who had a prophylactic bilateral mastectomy is coded:

– M1021a: Z48.89, Aftercare for other specified surgical aftercare

– M1023b: Z15.01, Genetic susceptibility to malignant breast neoplasm

– M1023c: Z80.3, Family history of malignant neoplasm of breast

– M1023d: Z90.13, Acquired absence of bilateral breasts and nipples

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Guidelines: Complications

• When the admission/encounter is for management of a complication associated with a neoplasm, such as dehydration, and the treatment is only for the complication, (e.g., intravenous rehydration), the complication is coded first, followed by the appropriate code(s) for the malignancy. (§ I.C.2.c.3)

1. Complication: E86.0, Dehydration

2. Malignancy: Neoplasm

• When the admission/encounter is for management of a complication associated with a neoplasm or treatment of a complication resulting from a surgical procedure:(§ I.C.2.c.4)

1. Surgical complication coded first, if treatment is directed at resolving the complication.

2. Code either current or history of neoplasm as appropriate

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Neoplasm-related Pain

• G89.3 Neoplasm related pain (acute) (chronic) is used for:

– Cancer associated pain

– Pain due to malignancy (primary)(secondary)

– Tumor associated pain

➢ Encounter for PAIN MANAGEMENT

• It is not necessary to also code the site of the pain, for example, M79.621, Pain in right upper arm.

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Remission

• Category C90, Multiple myeloma and malignant plasma cell neoplasms, and categories for leukemia (C91-C95) have codes indicating whether or not remission has been achieved.

• The 5th character identifies:• 0 - not having achieved remission

• 1 - in remission

• 2 - in relapse

• If the documentation is unclear as to whether the leukemia has achieved remission, query the provider.

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Use Additional Code

• Where applicable, many of the malignant neoplasm codes have

a + with the category, indicating there is a convention to use an

additional code:

If the physician has

documented or

verified these

conditions, then they

should be coded as

well.

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Finding the Code in the Alpha Index

• If the neoplasm is specified by its morphology or histology (e.g., adenoma, myoma, sarcoma), go to the Index first in order to determine the behavior

– Index: Adenoma – see also Neoplasm, benign, by site

• Some morphology types, such as carcinoid tumors and neuroendocrine tumors, are only found in the Alpha Index (not in the Neoplasm Table).

• Follow the notes in the Index.

• If the Index lists the behavior and the site:

– Go to the Tabular List to verify the code – e.g., Myoma of prostate = D29.1

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The Neoplasm Table

• If the Index lists the behavior but not the site:

– Go to the Neoplasm Table, Unknown site to find the code

– Verify the code in the Tabular List

• If the site(s) and behavior are known, go to the Neoplasm Table.

– Sometimes the diagnostic statement will tell you…

• Malignant neoplasm of the skin

• Benign fibroadenoma of the left breast

• If malignant, are there any secondary (metastatic) sites?

– Look for terms such as primary site, mets to…, mets from…

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The Neoplasm Table

Neoplasms are listed in alphabetical order by body site with

subentry modifiers for more specificity to site.

MalignantPrimary

MalignantSecondary Ca In Situ Benign

Uncertain Behavior

Unspecified Behavior

Neoplasm, neoplastic (show

more)

C80.1 C79.9 D09.9 D36.9 D48.9 D49.9

brain NEC C71.9 C79.31 D33.2 D43.2 D49.6basal ganglia C71.0 C79.31 D33.0 D43.0 D49.6

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MalignantPrimary

MalignantSecondary Ca In Situ Benign

Uncertain Behavior

Unspecified Behavior

Neoplasm, neoplastic(show more)

lung C34.9 C78.0 D02.2 D14.3 D38.1 D49.1azygos lobe

C34.15

C78.05

D02.25

D14.35

D38.1 D49.1

The Neoplasm Table

Watch for laterality!

➢ So, go to C34.1 in the Tabular List

➢ C34.1 Malignant neoplasm of upper lobe, bronchus or lung

➢ C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung

➢ C34.11 Malignant neoplasm of upper lobe, right bronchus or lung

➢ C34.12 Malignant neoplasm of upper lobe, left bronchus or lung

Indicates need for a 5th character (on-line version)In the book, indicated as C34.1- (- indicates more characters needed)

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Various Conditions

Breast Cancer Anemia Neoplasm of Transplanted Organs Organ Removal Pathological Fracture due to NeoplasmJoint Replacement due to NeoplasmTransplant care

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Breast Cancer - Mastectomy

• If the patient has a mastectomy due to neoplasm: (§I.C.21)

– Z48.3, Aftercare following surgery for neoplasm

– Neoplasm code (active or history)

– Z90.1-, Acquired absence of (site) breast and nipples

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Anemia and Neoplasm

• If the patient has neoplasm and anemia in the H&P, can the relationship be assumed or does it have to be specifically stated by the physician?

• Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound) D64.9

+ in (due to) (with)

• chronic kidney disease D63.1

• end stage renal disease D63.1

• failure, kidney (renal) D63.1

• neoplastic disease(See Also Neoplasm) D63.0

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Anemia – malignancy and therapies

When the admission/encounter is for management of an anemia associated with the malignancy and the treatment is only for anemia, sequence the appropriate code for the malignancy as the principal or first-listed diagnosis, followed by the appropriate anemia code (such as D63.0). (§ I.C.2.c.1)

1. Neoplasm code

2. D63.0, Anemia in neoplastic disease

When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the treatment is only for anemia, the anemia code is sequenced first, followed by the appropriate codes for the neoplasm and the adverse effect. (§ I.C.2.c.2)

1. D64.81, Anemia due to antineoplastic chemotherapy

2. Neoplasm code

3. T45.1X5D, Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter

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Anemia and radiotherapy

When the admission/encounter is for management of an anemia

associated with an adverse effect of radiotherapy, sequence the

anemia first, followed by the appropriate neoplasm code and code

Y84.2. (§ I.C.2.c.2)

1. D61.2, Aplastic anemia due to radiation

2. Neoplasm code

3. Y84.2, Radiological procedure and radiotherapy as cause of abnormal reaction of patient or of later complication, without mention of misadventure at time of procedure

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Malignant Neoplasm of Transplanted Organ

A malignant neoplasm of a transplanted organ is coded as an “other complication

of transplant, unless specified by the physician as failure or rejection”. (§ I.C.2.r)

– Index: Complication transplant

– Follow instructional note at T86 to ‘use an additional code for malignancy associated with organ transplant (C80.2)’.

• C80.2 instructs to code first complication of transplanted organ (T86.-) – and to use additional code to identify the specific malignancy.

1. T86.-, Complications of transplanted organs and tissue

2. C80.2, Malignant neoplasm associated with transplanted organ

3. Malignant neoplasm

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Pathological Fracture due to Neoplasm

When an encounter is for a pathological fracture due to a

neoplasm, and the focus of treatment is the fracture: (§ I.C.2.l.6)

1. Sequence first: a code from subcategory M84.5-, Pathological fracture in neoplastic disease

2. Next: the neoplasm

If the focus of treatment is the neoplasm with an associated

pathological fracture: (§ I.C.2.l.6)

1. Sequence first: the neoplasm

2. Next: a code from M84.5- for the pathological fracture

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Joint Replacement due to Neoplasm

Patient has bone mets, required a THR. Do you code Aftercare joint replacement, or Aftercare neoplasm? (§ I.C.21.c.7)

• Z48.3, Aftercare following surgery for neoplasm

• Metastasis code (E.g. C79.51, Secondary malignant neoplasm of bone)

• Z96.64-, Presence of artificial hip joint status

• Add code for either primary neoplasm or history of primary neoplasm as well

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Neoplasm along with a Transplant

When an encounter is for aftercare of an organ transplant due to a neoplasm: do you use Z94.-, Transplanted organ and tissue status, or Z48.3, Aftercare following surgery for neoplasm?

– Both! They would typically entail separate/different care, both codes paint the complete picture.

Example: Patient has liver cell carcinoma and had a liver transplant.

1. Z48.3, Aftercare following surgery for neoplasm

2. Z94.4, Liver transplant status

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Let’s Walk Through These Scenarios

Mastectomy Anemia due to neoplasm

Pathological Fracture Dehydration due to neoplasm

Transplant Complication History of neoplasm with neuropathy

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Post-Mastectomy

➢ Patient has been admitted to HH for post-mastectomy care due to malignant neoplasm of the breast, upper inner quadrant. She will continue with chemotherapy after HH is completed. H&P indicates she is estrogen receptor positive.

So, what do we need to know?Focus of care:

AC mastectomyIs the focus related to, or due to, anything?

Breast neoplasmDo we need further clarification from the physician or clinician for any diagnosis?

Documentation indicates it is the right breast

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Coding for Post-MastectomyDiagnosis ICD-10-CM

M1021a Aftercare following surgery for neoplasm Z48.3

M1023b Malignant neoplasm of upper-inner quadrant of right female breast

C50.211

M1023x Estrogen receptor positive status [ER+] Z17.0

M1023x Acquired absence of right breast and nipple Z90.11

M1023x Attention to surgical dressing Z48.01

Rationale (ref. slide 14):❑ The mastectomy is the focus of care, so it is coded first (primary).❑ Laterality is important, as the unspecified code (6th character ‘9’) has no Clinical

Grouping classification, and no eligible Comorbidity Subgroup under PDGM.❑ The breast cancer and estrogen receptor status are listed next.❑ As the patient is still receiving chemo for the breast cancer, it is still coded as

active.❑ Acquired absence of the breast is coded.

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Pathological Fracture & Neoplasms

➢ Patient has metastatic bone cancer from the lung, which had been removed. Her oncologist documented that the lung cancer was eradicated with the surgery. She has chronic pain and is taking Morphine.

➢ While standing at home, she felt a sudden sharp pain in her hip. She went to the ER, where it was determined that she had a fracture at the neck of the femur and worsening of her anemia due to the cancer.

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Code Pathological Fracture

So, what do we need to know?– Focus of care:

• The primary focus of care is physical therapy due to the fracture of the right femur.

• Nursing will address her anemia and pain management.

– Is the focus related to, or due to, anything?

• Fracture is due to the cancer.

– Do we need further clarification from the physician or clinician for any diagnosis?

• The affected lung is the left lung.

• The chronic pain is due to the cancer.

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Coding for Pathological FractureDiagnosis ICD-10-CM

M1021a Pathological fracture in neoplastic disease, (R) femur M84.551D

M1023b Secondary malignant neoplasm of bone C79.51

M1023c Neoplasm related pain G89.3

M1023d Anemia in neoplastic disease D63.0

M1023e Personal history of other malignant neoplasm of bronchus and lung Z85.118

M1023f Acquired absence of lung Z90.2

Other Long-term (current) use of opiate analgesic Z79.891

Rationale: (ref. slide 37):❑ The pathological fracture is the focus of care, so it is coded first (primary).

Laterality is important, as the unspecified code (7th character ‘9’) has no Clinical Grouping classification, and no eligible Comorbidity Subgroup under PDGM.

❑ The bone cancer, the cause of the fracture, pain, and anemia, are listed next.❑ The lung cancer was eradicated with the removal of the lung. Therefore, personal history of the cancer

and acquired absence of the lung are coded.

❑ What if pain management was the focus of care?

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Transplant Complication

➢ Patient had a left kidney transplant 5 years ago and was diagnosed with cancer in that kidney 2 months ago. Physician documentation notes kidney transplant failure.

So, what do we need to know?– Focus of care:

• Kidney transplant failure

– Is the focus related to, or due to, anything?

• Kidney cancer

– Do we need further clarification from the physician or clinician for any diagnosis?

• Physician documentation notes kidney transplant failure due to the cancer in the renal pelvis of the left kidney.

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Transplant Complication

➢ Patient had a left kidney transplant 5 years ago and was diagnosed with cancer in that kidney 2 months ago. Physician documentation notes kidney transplant failure due to the cancer in the renal pelvis of the left kidney.

Rationale (ref. slide 36):1. T86.-, Complications of transplanted organs and tissue2. C80.2, Malignant neoplasm associated with transplanted organ3. Malignant neoplasm code; Laterality is important, as the unspecified code (4th character ‘9’)

has no Clinical Grouping classification, and no eligible Comorbidity Subgroup under PDGM.

T86.12, Kidney transplant failure

C80.2, Malignant neoplasm associated with transplanted organ

C65.2, Malignant neoplasm of left renal pelvis

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Anemia due to Neoplasm

➢ Patient had been hospitalized for descending colon cancer, and was found to be severely anemic following removal of part of the colon. HH will administer IV meds and transfuse as necessary to treat the anemia. The physician has not stated the cancer is eradicated. While the colon is healing, a temporary colostomy bag is in place, which the family is uncomfortable changing.

So, what do we need to know?

– Focus of care:

• The primary focus of care is the anemia.

– Is the focus related to, or due to, anything?

• The physician has stated the anemia is due to the colon cancer.

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Coding for Anemia due to Neoplasm

Rationale (ref. slide 34):

1. Neoplasm

2. D63.0, Anemia in neoplastic disease

❑ The anemia due to the neoplasm is the focus of care, but per coding guidelines, the neoplasm is coded first (primary), followed by the anemia.

❑ The colostomy, vascular device attention, and absence of (partial) intestine are listed next.

❑ The colon cancer was not stated to be eradicated with the removal of the cancerous area. Therefore, the active neoplasm code is still used.

C18.6, Malignant neoplasm of descending colon

D63.0, Anemia in neoplastic disease

Z45.2, Encounter for adjustment and management of vascular access device

Z43.3, Encounter for attention to colostomy

Z90.49, Acquired absence of other specified parts of digestive tract

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History of Neoplasm with Neuropathy

➢ MD documents patient has neuropathy from previous cancer, but the neoplasm has been eradicated for years. The patient is taking medication for neuropathy.

So, what do we need to know?– Focus of care:

• Neuropathy

– Is the focus related to, or due to, anything?

• Neuropathy is due to prior cancer

– Do we need further clarification from the physician or clinician for any diagnosis?

• Cancer was ovarian cancer on the left side

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Coding for History of Neoplasm with Neuropathy

Diagnosis ICD-10-CM

M1021a Malignant neoplasm of left ovary C56.2

M1023b Polyneuropathy in diseases classified elsewhere G63

M1023x Personal history of malignant neoplasm of ovary Z85.43

• How do we signify that the neoplasm in M1021a is not “active”?

– In Symptom Control, enter a ‘0’

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Dehydration due to neoplasm

➢ Patient has referred to HH for IV rehydration due to severe dehydration as a result of throat cancer.

So, what do we need to know?

– Focus of care:

• Dehydration

– Is the focus related to, or due to, anything?

• The dehydration is due to the throat cancer.

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Coding for Dehydration due to neoplasm

E86.0, Dehydration

C14.0, Malignant neoplasm of throat

Z45.2, Encounter for adjustment and management of vascular access device

Rationale: When the admission/encounter is for management of a complication associated with a neoplasm, and the treatment is only for the complication, (e.g., intravenous rehydration), the complication is coded first, followed by the appropriate code(s) for the malignancy (ref. slide 23):

1. Complication: E86.0, Dehydration2. Malignancy: Neoplasm

❑ The encounter for IV care is listed as well.

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Proposed codes for October 1, 2019 (CY 2020)

• NONE for neoplasms!

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Quick Neoplasm-related Codes

• Z48.3, Aftercare following surgery for neoplasm

• G89.3, Neoplasm related pain (acute)(chronic)

• Personal history of neoplasm:

– Z85.0 – Z85.7, malignant neoplasm (primary)

– Z85.8-, malignant neoplasm (primary or secondary)

– Z86.018, benign neoplasm

– Z86.0-, in situ neoplasm

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Quick Neoplasm-related Codes

• Z17.-, Estrogen receptor status

• Z79.81-, Drug therapy codes

– Z79.810, Selective estrogen receptor modulators (SERMs)

– Z79.811, Aromatase inhibitors

– Z79.818, Agents affecting estrogen receptors and levels NEC

– Z79.899, Other (chemo)

• Z89.-, Acquired absence of limb

• Z90.-, Acquired absence of organs

• Z15.-, Genetic susceptibility to malignant neoplasm

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Thank you. Questions?

arlynn@therapyandmore.net

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