Coding Neoplasms by Site, Behavior, Classification Morphology or Histologic Type
Like other sections in ICD-10-CM , neoplasm chapter in ICD-10-CM has also some significant changes. Neoplasms are classified primarily by site and behavior. The behavior may be benign, carcinoma in-situ, malignant, uncertain behavior, and unspecified. However, in ICD-10-CM additional neoplasms are also classified by morphology or histologic type. Therefore, selecting the most specific code for some types of neoplasms will require documentation of the histologic type of the neoplasm. If a histological term is documented, that term should be referenced first, instead of going directly to the Neoplasm Table.
Based on the type of neoplasm and the site, the proper code is provided by the Neoplasm Table. The proper column in the table should be selected that corresponds to the type of neoplasm. The Tabular List should then be referenced to verify that the correct code has been coded and a more specific site code does not exist.
General Guidelines for Neoplasm Coding.
To assign the most specific code documentation must have the histologic behavior mentioned which may be
- Benign,
- In-situ,
- Malignant or of uncertain behavior.
Malignant neoplasms must be further differentiated as
- Primary or
- Secondary or metastatic sites.
How to refer the Alphabetic Index and Table of Neoplasms :
If the histological type is documented, then the histological behavior : benign, malignant, or uncertain behavior is determined. The neoplasm table is then used to identify the correct category, subcategory or code and the Tabular List is referenced for any additional coding instructions. The neoplasm table is not referenced, if a specific code is listed in the Alphabetic Index for the histological type. Additional coding instructions can be found in the Tabular list.The Neoplasm table does not need to be referenced in case of hepatoblastoma, which is listed in the Alphabetic Index, C22.2 Hepatoblastoma,
The neoplasm table is consulted to identify the correct code and the Tabular List is then reviewed for any additional coding instructions, if the histological type is not referenced but the histological behavior (benign, malignant, uncertain) is documented. Thorough review of the neoplasm chapter will be needed to identify all categories that will require more specific documentation.
Documentation Checklist for Assigning Neoplasm Codes for Solid Organ/Tissue Neoplasms
A checklist helps in identifying what additional documentation will be required for a number of solid organ/tissue neoplasms that have more specific codes in ICD-10-CM.Some codes are more specific to site and histologic type .The following points should be of great help while coding for neoplasm in ICD-10 :
For solid organ/tissue neoplasms:
- Site should be identified.
- Histologic behavior should be known
- Benign
- In situ
- Malignant has two sites
- Primary site
- Secondary (metastatic) site(s)
- Uncertain behavior
- Unspecified
- Histologic type for some organs/tissues
- Malignant neoplasms
- Liver and intrahepatic bile ducts
- Hepatocellular carcinoma or Liver cell carcinoma or Hepatoma
- Cholangiocarcinoma or Intrahepatic bile duct
- Hepatoblastoma
- Kupffer cell sarcoma or Angiosarcoma
- Other specific liver sarcomas
- Other specified liver carcinomas
- Unspecified type primary malignancy of liver
- Unspecified type, liver, not specified as primary or secondary
- Skin
- Basal cell carcinoma
- Malignant melanoma
- 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
- Liver and intrahepatic bile ducts
- In situ neoplasms
- Skin
- Melanoma in situ
- Carcinoma in situ
- Skin
- Benign neoplasms
- Skin
- Melanocytic nevi or
- atypical nevus or
- blue hairy pigmented nevus or
- nevus NOS
- Other benign neoplasms
- Uterus
- Leiomyoma
- Other benign neoplasm
- Neuroendocrine
- Benign carcinoid tumor
- Other benign tumor
- Skin
- Malignant neoplasms
- Laterality, should be identified for paired organs or extremities
- Sex, in case of breast neoplasm.