# ICD-10 Coding/Neoplasms

This lesson introduces ICD-10-CM Neoplasms.

## Objectives and Skills

Objectives and skills for this lesson include:
* Apply ICD-10-CM coding guidelines for accurate selection and sequencing of diagnosis codes commonly used to describe neoplasms
* Apply ICD-10-PCS coding guidelines for accurate selection of procedure codes commonly used to diagnose and treat neoplasms

## Guidelines

Guidelines Introduction Video
Chapter 2 Guidelines Powerpoint.

### Start Here
#### ICD-10-CM Official Guidelines for Coding and Reporting FY2019

Chapter 2 specific guidelines can be found on pages 29-36 of this document

### Part 2 : Procedures

Excision, Resection, or Destruction of a body part
Excision vs Resection
- Excision – sentinel lymph removed
- Resection – the entire lymph node chain removed
Destruction: physical eradication of all or a portion of a body part by direct use of energy, force, or a destructive agent (Ex. Laser: Radiation Therapy)
What is the root operation for “Antineoplastic chemotherapy”? Introduction

## Learning Resources

* Cancer Stem Cells
Cell Cycle : Cancer
Characteristics / Classifications of Neoplasms PPT
How to become a Cancer Registry Professional? Website
Common Surgical Procedures

## Activities

Cancer Pathophysiology Quiz
Visit the following the National Cancer Institute website and answer the following question: What is cancer?
Check your understanding:
* What is the difference between “remission” and “relapse”?
** Remission
*** When the disease lessens in severity
*** Symptoms decrease and treatment discontinued
** Relapse
*** Return of manifestations after an interval of improvement
*** May be a recurrence of the leukemia
* What is G89.3? code for neoplasm-related pain
* Where is the following guideline located ? ICD-10-CM / chapter 6 : Diseases of the Nervous System (G00 - G99)
** Coding Guideline:
** Neoplasm Related Pain Code G89.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic. This code may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis. When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not necessary to assign an additional code for the site of the pain. See Section I.C.2 for instructions on the sequencing of neoplasms for all other stated reasons for the admission/encounter (except for pain control/pain management).
* Skin Melanoma
What does term “Malignant” mean?
* Tending to become worse and cause death
* Describing a cancer
* Resistant to treatment
* Malignant neoplasms world map 2012

## Summary and Key Terms

BAM Table:
| Behavior (6 different choices) | Behavior (6 different choices) | Anatomical Site | Morphology type |
| 1) Malignant Primary | site where neoplasm originated | Lung, breast, etc. | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| Malignant Primary with Contiguous Sites | Overlaps 2 or more contiguous sites should be classified to the subcategory/code “.8” (unless the combination is specifically indexed elsewhere | Ex: Lesion of the jejunum and ileum | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| 2) Malignant Secondary | ·  site to which neoplasm has spread (also known as the metastatic site) ·  patient may have a metastatic tumor, but the site of the primary tumor cannot be found ·  “new primary” occurs when patient develops cancer a second time and is unrelated to the first cancer site ·  “recurrence” is when the original cancer recurs in the same organ ·  Cells of the secondary site do not resemble the cells of the organ where it was found -   Patient stated as having an unknown primary origin -   Code for secondary site where found -   Code for primary malignant of unknown site | | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| 3) In situ (in place) | malignant changes in cells but surrounding tissue has not been invaded | | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| 4) Benign | tumor growth does not invade adjacent structures or spread to distant sites | | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| 5) Uncertain | pathologist cannot determine whether benign or malignant | | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |
| 6) Unspecified   Behavior | neither the behavior nor the histology is specified in the diagnosis Ex: “Growth,” “Neoplasm,” “Tumor” | | ·  describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc. If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries ·  For example, lipoma, melanoma, sarcoma have specific codes included in the Index ·  However, not every entry in Index will include codes ·  For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain) |

## See Also

https://en.wikipedia.org/wiki/ICD-10_Chapter_II:_Neoplasms
Reporting Pain in ICD-10-CM