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9/16/2013Coding of Neoplasms in ICD-10-CMPresented by Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMCAAPC ICD-10 Training ExpertAAPCCA Board of Directors1No part of this presentation may bereproduced or transmitted in any formor by any means (graphically,electronically, or mechanically,including photocopying, recording, ortaping) without the expressed writtenpermission of AAPC.Coding of Neoplasms in ICD-10-CM2Agenda Carcinomas In SituNeoplasm of the BreastColorectal NeoplasmsUpper GI NeoplasmsNeoplasms of PancreasSkin CancersCoding of Neoplasms in ICD-10-CM31
9/16/2013Carcinoma In Situ Carcinoma In Situ (CIS)–––––Cancerous tumorsNoninvasiveConfinedLatin for “in its place”Bowen’s diseaseExamplePatient was seen in follow up for carcinoma in situ of theskin of the breast.D04.5 Carcinoma in situ of skin of trunkCoding of Neoplasms in ICD-10-CM4Synonyms for In Situ Carcinoma Adenocarcinoma in anadenomatous polyp withno invasion of the stalk „Confined to theepithelium „Noninfiltrating „Intraepithelial Intraepidermal (anus) „Involvement up to butnot including thebasement membranes „Noninvasive „No stromal involvement „Papillary noninfiltratingCoding of Neoplasms in ICD-10-CM5Example A 57-year-old patient presents for anesthesiaevaluation. The patient has a family history of amother and sister with premenopausal breastcancer. Digital mammography shows area ofcalcifications. Magnification views demonstrateintraductal pleomorphic microcalcifications in theright 11:00 area. Final diagnosis indicatedintraductal carcinoma in situ.D05.11 Intraductal carcinoma in situ of right breastZ80.3 Family history of malignant neoplasm of breastCoding of Neoplasms in ICD-10-CM62
9/16/2013Benign Neoplasms NoncancerousDo not metastasizeHave defined edgesDo not grow backCoding of Neoplasms in ICD-10-CM7Types of Breast Cancers Ductal carcinomaLobular carcinomaInflammatory breast cancerMedullary carcinomaMucinous carcinomaPage disease of the nipplePhyllodes tumorTubular carcinomaCoding of Neoplasms in ICD-10-CM8Coding of Neoplasms in ICD-10-CM93
9/16/2013Example A 57-year-old patient presents for evaluation of right nipplediscomfort. The patient has family history of a mother and sisterwith premenopausal breast cancer. Digital mammographyshows area of calcifications. Magnification views demonstrateintraductal pleomorphic microcalcifications in the right 11o’clock area. Final diagnosis indicated intraductal carcinoma insitu.D05.11 Intraductal carcinoma in situ of right breastZ80.3 Family history of malignant neoplasm of breastCoding of Neoplasms in ICD-10-CM 10Colorectal NeoplasmsCoding of Neoplasms in ICD-10-CM 11Document by CentimetersAnus 0–4 cm„Rectum 4–16 cm– Upper third is covered by peritoneum; the lower third is not and it is also calledthe rectal ampulla„Rectosigmoid 15–17 cm– From the anal verge„Sigmoid 17–57 cm– Loop extending distally from border of left posterior major psoas muscle„Descending 57–82 cm– Approximately 10–15 cm long and located behind the peritoneum„Transverse 82–132 cm– Lies anteriorly in the abdomen and attached to the gastrocolic ligament„Ascending 132–147 cm– Approximately 20–25 cm long and located behind the peritoneum„Cecum 150 cm– Approximately 6x9 cm pouch covered with peritoneumCoding of Neoplasms in ICD-10-CM 124
9/16/2013Colorectal NeoplasmsIn ICD-10-CM the codes for neoplasms are site specific C18.0 Malignant neoplasm of cecumC18.1 Malignant neoplasm of appendixC18.3 Malignant neoplasm of ascending colonC18.4 Malignant neoplasm of hepatic flexureC18.5 Malignant neoplasm of transverse colonC18.6 Malignant neoplasm of splenic flexureC18.8 Malignant neoplasm of overlapping sites of colonC18.9 Malignant neoplasm of colon, unspecifiedCoding of Neoplasms in ICD-10-CM 13Colorectal Neoplasms A benign neoplasm of the colon (adenomatous colonpolyp) is coded to the subcategory of D12 according tothe sites listed above as defined by the 4th character.ExampleDuring a screening colonoscopy, Dr. Smith removes apolyp from the descending colon. Pathology reportsconfirm it is benign.D12.4 Benign neoplasm of descending colonCoding of Neoplasms in ICD-10-CM 14Upper GI NeoplasmsCoding of Neoplasms in ICD-10-CM 155
9/16/2013Neoplasms of PancreasCoding of Neoplasms in ICD-10-CM 16Neoplasms of Pancreas C25.0 Malignant neoplasm of head of pancreasC25.1 Malignant neoplasm of body of pancreasC25.2 Malignant neoplasm of tail of pancreasC25.3 Malignant neoplasm of pancreatic ductC25.4 Malignant neoplasm of endocrine pancreas– Malignant neoplasm of islets of Langerhans– Use additional code to identify functional activity C25.7 Malignant neoplasm of other parts of pancreas– Malignant neoplasm of neck of pancreas C25.8 Malignant neoplasm of overlapping sites of pancreas C25.9 Malignant neoplasm of pancreas, unspecifiedCoding of Neoplasms in ICD-10-CM 17ExampleA patient was diagnosed with operableadenocarcinoma of the pancreas tail.C25.2 Malignant neoplasm of tail ofpancreasCoding of Neoplasms in ICD-10-CM 186
9/16/2013NeoplasmMelanoma (malignant)Skinknee C43.7labium C51.9majus C51.0minus C51.1leg C43.7lip (lower) (upper) C43.0 C43.472 Malignant melanoma of left lower limb,including hipCoding of Neoplasms in ICD-10-CM 19MalignantPrimaryMalignantSecondaryCa insituBenignUncertainBehaviorUnspecifiedskin NOSC44.09C79.2D04.9D23.9D48.5D49.2calf (see alsoNeoplasm, skin,limb, lower)C44.70-C79.2D04.7-D23.7-D48.5D49.2limb NECC44.90C79.2D04.9D23.9D48.5D49.2basal .2D48.5D49.2basal cellcarcinomaC44.71----specified typeNECC44.79----squamous ---------Coding of Neoplasms in ICD-10-CM 20---------Neoplasm C44.70- Unspecified malignant neoplasm ofskin of lower limb, including hip– C44.79- Other specified malignant neoplasm ofskin of lower limb, including hip C44.793 Other specified malignant neoplasmof skin of left lower limb, including hip Correct code C43.72 Malignant melanoma ofleft lower limb, including hipCoding of Neoplasms in ICD-10-CM 217
9/16/2013Melanoma In males, more common on the back In females, more common on the legs Terminology– Breslow thickness– Clark level Level 1Level 2Level 3Level 4Level 5In situ melanomaMelanoma has invaded the papillary dermisMelanoma has filled the papillary dermisMelanoma has invaded the reticular dermisMelanoma has invaded subcutaneous tissueCoding of Neoplasms in ICD-10-CM 22MelanomaC43.1- Malignant melanoma of eyelid,including canthusC43.3- Malignant melanoma of other anunspecified parts of faceC43.5- Malignant melanoma of trunkC43.6- Malignant melanoma of upper limb,including shoulderC43.7- Malignant melanoma of lower limb,including hipCoding of Neoplasms in ICD-10-CM 23Example Jack returns to the dermatologist’s office aftera biopsy of a mole on his back. He isdiagnosed with malignant melanoma of theback. C43.59of trunkMalignant melanoma of other partCoding of Neoplasms in ICD-10-CM 248
9/16/2013Example A patient presents for treatment options tothe dermatologist after having a biopsyproven melanoma in situ on her rightshoulder. D03.61 Melanoma in situ of right upper limb,including shoulderCoding of Neoplasms in ICD-10-CM 25Basal Cell Carcinoma (BCC) Most common type of skin cancer About 80% of skin cancer cases are BCC Begins in the basal cells located in theepidermis Tend to grow slowly Rarely metastasizeCoding of Neoplasms in ICD-10-CM 26Basal Cell Carcinoma (BCC) Category C44 contains the codes for BCC– Broken down in the same manner as melanomaand Merkel cell carcinoma– 5th character 1 in the code category indicatesthe type of carcinoma to be basal cell C44.112 Basal cell carcinoma of skin of righteyelid, including canthus C44.219 Basal cell carcinoma of skin of left earand external auricular canalCoding of Neoplasms in ICD-10-CM 279
9/16/2013Example 70-year-old May presents with a history ofbasal cell carcinoma of the right thigh twoyears ago. She complains of 2 months ofcrusting on the right nasal tip. Patient with along history of sun exposure with multiple badsunburns. Biopsy reveals new basal cellcarcinoma of the nasal tip. The patient willundergo Mohs surgery. C44.311 Basal cell carcinoma of skin of nose Z85.828 Personal history of other malignantneoplasm of skinCoding of Neoplasms in ICD-10-CM 28Example A patient presents for treatment options forhis basal cell carcinoma on his left ear. He hasdone some research and is asking aboutexcision, Mohs, radiation, cryosurgery,photodynamic therapy, and 5-fluorouracil.After discussion, he decides on surgicalexcision. C44.219 Basal cell carcinoma of skin of leftear and external auricular canalCoding of Neoplasms in ICD-10-CM 29Squamous Cell Carcinoma (SCC) Second most common type About 700,000 cases in the U.S. each year Tend to grow and metastasize more thanBCCs More likely to invade fatty tissue beneaththe skin More likely to metastasize to lymph nodesCoding of Neoplasms in ICD-10-CM 3010
9/16/2013Squamous Cell Carcinoma (SCC) Category C44 contains the codes for BCC– Broken down in the same manner as melanomaand Merkel cell carcinoma– 5th character 2 in the code category indicatesthe type of carcinoma to be squamous cell C44.122 Squamous cell carcinoma of skin of righteyelid, including canthus C44.229 Squamous cell carcinoma of skin of leftear and external auricular canalCoding of Neoplasms in ICD-10-CM 31Example A patient returns to the dermatologist todiscuss removal of his SCC on his lower lip. C44.02lipSquamous cell carcinoma of skin ofCoding of Neoplasms in ICD-10-CM 32Example A patient has a suspicious lesion removedfrom the back of his right hand. The patient isinformed that the biopsy results confirmsquamous cell carcinoma. C44.622 Squamous cell carcinoma of skin ofright upper limb, including shoulderCoding of Neoplasms in ICD-10-CM 3311
9/16/2013Merkel Cell Carcinoma (MCC) Rare form Develops in the neuroendocrine cells– Hormone-making cells in the skin Thought to be caused from sun exposure andMerkel cell polyomavirus (MCV) About 1,500 cases in the U.S. each year Often metastasize the lymph nodes andinternal organsCoding of Neoplasms in ICD-10-CM 34Non-Melanoma Skin Cancer Category C44 contains the codes for basal cellcarcinoma, squamous cell carcinoma, other,and unspecified malignant neoplasms of theskin Category C4A contains the codes for Merkelcell carcinoma Break down by type, site, and laterality (insome cases)Coding of Neoplasms in ICD-10-CM 35Example 75-year-old male patient presents with arapidly enlarging mass near his upper lip. Heis fair skinned and lives on a farm, using nosun protection other than a baseball cap. Themass has been rapidly increasing in size forthe past 2 months. After diagnostic testing heis diagnosed with Merkel cell carcinoma of theperi-oral area. C4A.39 Merkel cell carcinoma of otherparts of faceCoding of Neoplasms in ICD-10-CM 3612
9/16/2013Questions?CEU #Coding of Neoplasms in ICD-10-CM 3713
Coding of Neoplasms in ICD-10-CM Melanoma (malignant) Skin knee C43.7- labium C51.9 majus C51.0 minus C51.1 leg C43.7-lip (lower) (upper) C43.0 C43.472 Malignant melanoma of left lower limb, including hip Neoplasm 19 Coding of Neoplasms in ICD-10-CM Malignant Primary Malignant Secondary Ca in situ Benign Uncertain Behavior Unspecified
