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Neo means New Plasma means Formation Abnormal growth of tissue caused by rapid division of cells that have undergone some form of mutation. Types of Neoplasms Benign neoplasm : Non cancerous tumour that lacks ability to invade neighbouring tissue. Not usually life threatening Eg: Adenomas, Fibromas, Lipomas, Osteoma, Papilloma, Chondoma etc.. Malignant neoplasm : A malignant neoplasm is a cancerous tumor , an abnormal growth that can grow uncontrolled and spread to other parts of the body. Eg: Carcinoma, Lymphoma, Leukaemia, Sarcoma, Melanoma etc.. Malignant neoplasm (Secondary): Neoplasm that has spread (metastasized) from the place where it first started to another part of the body. Carcinoma insitu: A condition in which in which tumour is till confined to the site from which it is started and has not spread to surrounding tissue or organ. Uncertain behaviour: A lesion whose behaviour cannot be predicted. It’s currently benign but there is a chance it could undergo malignant transformation. Types of cancer treatment Surgery is a procedure where surgeon removes cancer from body. Radiation Therapy uses high doses of radiation to kill cancer cells.
Chemotherapy Usage of most toxic drugs to kill cancer cells. Side effects: Immunosuppression, Typhlitis, Gastrointestinal distress, Anemia, Fatigue, Nausea, Vomiting, hairloss, infertility, organ damage and other side effects. Immuno therapy helps immune system to fight cancer. Eg: Monoclonal antibodies, cytokines, vaccines. Targeted therapy Hormone therapy Stem cell transplant How to code If histological term is documented then term should be referred in alphabetic index ; if not the term should be search in neoplasm table to determine appropriate column. Eg: Adenoma: refer in alphabetic index under this term “see also neoplasm , by site, benign”. The table provides proper code based on type of neoplasm and site. To properly code a neoplasm it is necessary to determine from the record if the neoplasm is benign, in-situ, malignant, or of uncertain histologic behaviour. If malignant, any secondary(metastatic) sites should also be determined. Primary malignant neoplasms overlapping site boundaries A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8('overlapping lesion'), unless the combination is specifically indexed elsewhere. Eg: A 62-year-old female with a malignant lesion of the upper lip that extends from the lipstick area to the labial frenulum C00.8 Malignant neoplasm of overlapping sites of lip Explanation : Because this is a single lesion that overlaps two contiguous sites, a single code for overlapping sites is assigned. For multiple neoplasms of the same site that are not contiguous such as tumours in different quadrants of the same breast, codes for each site should be assigned. Eg: A 74-year-old male is treated for two distinct malignant lesions, one in the mucosa of the upper lip and a second in the mucosa of the lower lip. C00.3 Malignant neoplasm of upper lip, inner aspect C00.4 Malignant neoplasm of lower lip, inner aspect Explanation : This patient has two distinct malignant lesions of the upper and lower lips. Because the lesions are not contiguous, two codes are reported. Malignant neoplasm of ectopic tissue: Malignant neoplasms of ectopic tissue are to be coded to the site of origin mentioned. Eg ectopic pancreatic malignant neoplasms involving the stomach are coded as: Malignant neoplasm of pancreas, unspecified (C25.9). Treatment directed at the malignancy: If the treatment is directed at the malignancy, designate the malignancy as the principal diagnosis. Exception: If a patient admission/encounter is for: Administration of chemotherapy
He is referred today for a blood transfusion to treat anemia related to radiation therapy. D64.89 Other specified anemias C20 Malignant neoplasm of rectum Y84.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient Explanation : The code for the anemia is sequenced first, followed by the code for the malignancy, and lastly the code for the abnormal reaction due to radiotherapy. Management of dehydration due to the malignancy: When the admission/encounter is for management of dehydration due to the malignancy and only the dehydration is being treated then the dehydration is sequenced first, followed by the code(s) for the malignancy. Treatment of a complication resulting from a surgical procedure: When the admission/encounter is for treatment of a complication resulting from a surgical procedure, designate the complication as the principal or first-listed diagnosis if treatment is directed at resolving the complication. Primary malignancy previously excised: When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code 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. Eg: History of lung cancer, left upper lobectomy 18 months ago with no current treatment; MRI of the brain shows metastatic disease in the brain C79.31 Secondary malignant neoplasm of brain Z85.118 Personal history of other malignant neoplasm of bronchus and lung Episode of care involves surgical removal of neoplasm: When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by adjunct chemotherapy or radiation treatment during the same episode of care, the code for the neoplasm should be assigned as principal or first-listed diagnosis. Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or external beam radiation therapy assign codes: Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence.
The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis. Eg: Patient presents for second round of rituximab and fludarabine for his chronic B cell lymphocytic leukemia Z51.11 Encounter for antineoplastic chemotherapy Z51.12 Encounter for antineoplastic immunotherapy C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission. Explanation : Rituximab is an antineoplastic immunotherapy while fludarabine is an antineoplastic chemotherapy. The two treatments are often used together. The encounter was solely for the purpose of administering this treatment and either can be sequenced first, before the neoplastic condition. If a patient admission/encounter is for the insertion or implantation of radioactive elements (e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the principal or first- listed diagnosis. Patient admitted for radiation therapy, chemotherapy or immunotherapy and develops complications: When a patient is admitted for the purpose of external beam radiotherapy, immunotherapy or chemotherapy and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is: Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, Z51.12, Encounter for antineoplastic immunotherapy followed by any codes for the complications. When a patient is admitted for the purpose of insertion or implantation of radioactive elements (e.g., brachytherapy)and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is the appropriate code for the malignancy followed by any codes for the complications. Admission/encounter to determine extent of malignancy: When the reason for admission/encounter is to determine the extent of the malignancy, or for a procedure such as paracentesis or thoracentesis, the primary malignancy or appropriate metastatic site is designated as the principal or first-listed diagnosis, even though chemotherapy or radiotherapy is administered. Eg: Patient with left lung cancer with malignant pleural effusion being seen for thoracentesis and initiation/administration of chemotherapy C34.92 Malignant neoplasm of unspecified part of left bronchus or lung J91.0 Malignant pleural effusion Z51.11 Encounter for antineoplastic chemotherapy Explanation : The lung cancer is sequenced before the chemotherapy this instance because the paracentesis for the malignant effusion is also being performed. An instructional note under the malignant effusion instructs that the lung cancer be sequenced first.
neoplasm code should be sequenced first, f/o by M84.5 for the pathological fracture. Current malignancy versus personal history of malignancy When a primary malignancy has been excised but 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. Eg: Female patient with ongoing chemotherapy after right mastectomy for breast cancer C50.911 Malignant neoplasm of unspecified site of right female breast Z90.11 Acquired absence of right breast and nipple. Explanation : Even though the breast has been removed, the breast cancer is still being treated with chemotherapy and therefore is still coded as a current condition rather than personal history. When a primary malignancy has been previously excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is 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. Malignant neoplasm associated with transplanted organ A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign first the appropriate code from category T86.-, Complications of transplanted organs and tissue, followed by code C80.2, Malignant neoplasm associated with transplanted organ.
