Complete Guide to the Neoplasm Table in ICD-10-CM for Beginner Medical Coders

Contempo Coding
8 Jul 202112:35
EducationalLearning
32 Likes 10 Comments

TLDRIn this informative video, Victoria, a medical coder auditor educator, guides viewers through the intricacies of the ICD-10-CM neoplasm table. She explains the importance of understanding the chapter two guidelines for neoplasm sequencing, the exceptions to the rules, and how to correctly use the table for various cancer scenarios including primary malignancies, metastatic sites, carcinoma in situ, benign neoplasms, and uncertain or unspecified behaviors. Victoria also emphasizes the need to follow the alphabetical structure and indentations within the table to ensure accurate coding, and provides practical examples to illustrate the process.

Takeaways
  • 📚 The ICD-10-CM manual contains three tables: neoplasms, drugs and chemicals, and external causes of injury.
  • 👩‍🏫 Victoria, a medical coding educator, provides insights on navigating the table of neoplasms for medical coding purposes.
  • 📈 Neoplasms are categorized in Chapter 2 of ICD-10-CM, with strict guidelines for coding sequence, especially for primary malignancies.
  • 🔄 Exceptions to coding rules exist, such as using a secondary cancer code as the primary diagnosis for metastatic sites under chemotherapy.
  • 📖 Some neoplasms have specific index entries and are not coded using the neoplasm table, like actinic keratosis.
  • 📌 Codes followed by a dash in the neoplasm table require an additional character, which is found in the tabular list.
  • 📊 The neoplasm table includes categories for primary malignancy, secondary (metastatic), carcinoma in situ, benign, uncertain behavior, and unspecified behavior.
  • 🔎 When coding neoplasms, pay close attention to the indentations and columns for specificity, such as differentiating between abdomen wall and abdomen organ.
  • 📏 A ruler can be helpful when navigating the neoplasm table due to the small print and to ensure accurate column following.
  • 🌟 For skin cancer codes, it's recommended to start under the 'skin' term in the table for maximum specificity.
  • 📝 Always verify codes in the tabular list, not just from the neoplasm table, to ensure accuracy and completeness.
Q & A

  • What are the three tables in ICD-10-CM?

    -The three tables in ICD-10-CM are the Table of Neoplasms, the Table of Drugs and Chemicals, and the Table of External Causes of Injury.

  • What is the primary purpose of the Table of Neoplasms?

    -The primary purpose of the Table of Neoplasms is to provide a structured way to classify and code various types of cancer and tumors based on their origin, behavior, and site.

  • What is the significance of the chapter number for neoplasms in ICD-10-CM?

    -Neoplasms are classified under Chapter 2 of ICD-10-CM, which provides guidelines for coding and sequencing of neoplasms, including rules for primary and secondary malignancies.

  • What are some exceptions to the general rule of listing the primary cancer site first?

    -An exception to listing the primary cancer site first is when a patient is receiving chemotherapy treatment directed at a metastatic site; in such cases, the metastatic cancer can be used as a primary diagnosis.

  • How does the Table of Neoplasms handle cases where a specific code is followed by a dash?

    -If a code in the Table of Neoplasms is followed by a dash, it indicates the need for an additional character, such as laterality (right or left), which must be completed by referring back to the tabular list.

  • What are the six different categories in the Table of Neoplasms?

    -The six categories in the Table of Neoplasms are: Primary Malignancy, Secondary (Metastatic), Carcinoma in Situ, Benign, Uncertain Behavior, and Unspecified Behavior.

  • How does one determine the appropriate code for an unspecified lesion?

    -For an unspecified lesion, the code D49.2 is used, which refers to a neoplasm of unspecified behavior of bone, soft tissue, and skin. This is used when the provider has documented a lesion but did not specify its nature.

  • What is the correct approach to finding a code for lung cancer in the Table of Neoplasms?

    -To find a code for lung cancer, one should go to the 'L's in the Table of Neoplasms, locate the primary malignancy column (C34.9), and since the example does not specify the side, use the unspecified code C34.90.

  • How does the Table of Neoplasms guide the coding of a metastatic carcinoma?

    -For metastatic carcinomas, one should locate the primary organ in the Table of Neoplasms, find the secondary (metastatic) column, and use the appropriate code, such as C78.89 for secondary malignant neoplasm of other digestive organs.

  • What is the recommended method for finding skin cancer codes in the Table of Neoplasms?

    -For skin cancer codes, it is recommended to start under the term 'Skin' in the Table of Neoplasms and then proceed to the specific site, such as 'forearm', to ensure the most accurate and specific code is used.

  • How can one verify the codes found in the Table of Neoplasms?

    -Codes found in the Table of Neoplasms should be verified in the tabular list to ensure accuracy and completeness, as the table itself does not provide the full code, such as laterality or other necessary characters.

Outlines
00:00
📚 Introduction to ICD-10-CM Neoplasm Table

The video begins with Victoria, a medical coding educator, introducing the ICD-10-CM's Table of Neoplasms. She explains that there are three tables within ICD-10-CM: the Table of Neoplasms, the Table of Drugs and Chemicals, and the Table of External Causes of Injury. Victoria focuses on the Table of Neoplasms, providing an overview of its structure and usage. She emphasizes the importance of understanding Chapter 2 guidelines for neoplasm sequencing and the exceptions to the general rules, such as the primary malignancy usually being the first listed code except in certain cases like chemotherapy treatment. Victoria also discusses the need to familiarize oneself with the nuances of coding neoplasms and the specific entries in the alphabetic index that do not use the neoplasm table.

05:00
🔍 Navigating the Neoplasm Table

Victoria delves into the specifics of navigating the Neoplasm Table, explaining the importance of following the alphabetical order and understanding the indentations that indicate specificity. She clarifies the difference between uncertain and unspecified behavior in coding. The video provides examples of how to find codes for conditions like lung cancer, carcinoma in situ, and unspecified lesions, highlighting the need to verify codes in the tabular list and consider additional characters indicated by dashes in the table.

10:01
📈 Coding Examples and Table Navigation

In this section, Victoria demonstrates how to code for metastatic carcinoma of the gallbladder and basal cell carcinoma of the forearm using the Neoplasm Table. She emphasizes the importance of starting with broad terms like 'skin' for skin cancer codes to ensure specificity. Victoria also explains how to identify the correct code for metastatic cancer and the use of the dash in the table to indicate the need for an additional character. She invites viewers to request coverage of the Table of Drugs and Chemicals and the Table of External Causes in future videos.

Mindmap
Keywords
💡ICD-10-CM
ICD-10-CM stands for the International Classification of Diseases, 10th Revision, Clinical Modification. It is a coding system used in the United States for medical documentation and billing. In the video, the speaker discusses navigating through the ICD-10-CM to find specific codes for neoplasms, which is a crucial part of medical coding.
💡Neoplasms
Neoplasms are abnormal growths of tissue that can be either benign (non-cancerous) or malignant (cancerous). In the context of the video, the focus is on malignant neoplasms, and the speaker provides guidance on how to identify and code for different types of neoplasms using the ICD-10-CM table.
💡Primary Malignancy
A primary malignancy refers to the original site of a cancer in the body. It is the location where the cancer first develops. The video emphasizes the importance of identifying the primary malignancy when coding for neoplasms, as it typically takes precedence in the coding sequence.
💡Metastatic Site
A metastatic site is a location in the body where cancer has spread from its primary site. The term is used to describe secondary locations of cancer growth. In the video, the speaker discusses scenarios where the metastatic site may be coded as the primary diagnosis, such as during chemotherapy treatment.
💡Carcinoma in Situ
Carcinoma in situ is a type of cancer that has not spread or grown beyond its original site of occurrence. It is considered a pre-cancerous condition and is often treated as such. The video explains how to code for carcinoma in situ using the ICD-10-CM table.
💡Benign Neoplasms
Benign neoplasms are growths that are not cancerous. They do not invade nearby tissues or spread to distant parts of the body. In the video, the speaker categorizes benign neoplasms as a type of neoplasm and discusses their coding in the context of the ICD-10-CM.
💡Uncertain Behavior
Uncertain behavior in the context of neoplasms refers to a growth that has been examined and biopsied but cannot be definitively classified as benign or malignant. The video explains that uncertain behavior is different from unspecified behavior, as it involves an attempt to diagnose the lesion.
💡Unspecified Behavior
Unspecified behavior indicates a lack of specific information about a neoplasm. It means that the provider did not diagnose or formally examine the neoplasm, and only a general description of the lesion's location is provided. The video clarifies the difference between uncertain and unspecified behavior in coding.
💡Coding Sequence
Coding sequence refers to the order in which medical conditions and procedures are recorded and reported for billing and statistical purposes. The video discusses the strict guidelines for sequencing neoplasms in ICD-10-CM, highlighting the importance of following these rules for accurate medical coding.
💡Tabular List
The tabular list is a part of the ICD-10-CM that provides a structured format for classifying diseases and procedures. It is used in conjunction with the alphabetic index to find the correct codes. The video emphasizes the need to verify codes found in the neoplasm table by cross-referencing them in the tabular list.
💡Medical Coding
Medical coding is the process of converting healthcare procedures, diagnoses, and other medical information into universal medical codes for the purpose of billing and record-keeping. The video is a tutorial on medical coding, specifically focusing on the coding of neoplasms using the ICD-10-CM.
Highlights

The ICD-10-CM has three tables: Table of Neoplasms, Table of Drugs and Chemicals, and Table of External Causes of Injury.

The focus of the discussion is the Table of Neoplasms, which is covered in detail.

Victoria, a medical coder auditor educator and content creator, provides tips and tutorials for a successful medical coding career.

Neoplasms are found in Chapter 2 of ICD-10-CM and have strict sequencing guidelines.

Exceptions to the sequencing rules exist, such as when a patient receives chemotherapy treatment for a metastatic site.

Some neoplasms have specific alphabetic index entries and do not use the Table of Neoplasms.

Codes followed by a dash in the neoplasm table require an additional character for specificity, such as laterality.

The neoplasm table includes categories like primary malignancy, secondary (metastatic), carcinoma in situ, benign, uncertain behavior, and unspecified behavior.

Carcinoma in situ refers to a cancer that has not spread and is encapsulated at the site of origin.

Uncertain behavior refers to a lesion that has been examined but not definitively diagnosed.

The neoplasm table requires careful navigation due to its structured indentations and column-based layout.

For lung cancer, the code C34.90 is used for unspecified bronchus or lung cancer not otherwise specified.

Carcinoma in situ of the right kidney is coded as D09.19 when the specific side is not documented.

An unspecified lesion of the eyebrow is coded as D49.2, neoplasm of unspecified behavior of bone, soft tissue, and skin.

Metastatic carcinoma of the gallbladder is coded as C78.89, secondary malignant neoplasm of other digestive organs.

Basal cell carcinoma of the forearm is coded as C444.61 with an additional unspecified upper limb character.

It is recommended to start under the term 'skin' when looking up skin cancer codes for better specificity.

Transcripts

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Medical CodingNeoplasm TableICD-10-CMVictoria EducatorCancer DiagnosisPrimary MalignancyMetastatic CancerCarcinoma in SituCoding TutorialHealthcare Education