ICD 10 CM Chapter Specific Guidelines I. C2

Dr. Lisa L Campbell®

30 Jan 201925:54

EducationalLearning

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TLDRThis transcript discusses the intricacies of coding neoplasms according to ICD-10-CM guidelines, focusing on chapter 2 (C00-D49). It emphasizes the importance of understanding whether a neoplasm is malignant, primary or secondary, and the use of the neoplasm table for coding. The video covers various scenarios, including the sequencing of codes for complications, treatment focus, and the distinction between current malignancy and personal history. It also touches on the coding of malignancies associated with transplanted organs and the use of Z codes for therapy and personal history.

Takeaways

📚 Familiarize yourself with the Neoplasm Table in the ICD-10-CM for proper coding of neoplasms.
🧬 Determine if the neoplasm is malignant and whether it is primary or secondary to guide coding.
🌟 Understand overlapping site boundaries and use subcategory codes for neoplasms in multiple continuous sites.
🩺 Check the medical record for specific tissue type (e.g., carcinoma, lymphoma, sarcoma) before referring to the Neoplasm Table.
🔄 For encounters focused on malignancy treatment, assign the malignancy as the principal diagnosis unless it's for chemotherapy, immunotherapy, or radiation therapy.
🩹 If the focus is on a secondary site or related complication, sequence that as the principal diagnosis.
🤰 In cases of pregnancy with a malignant neoplasm, sequence pregnancy-related codes first, followed by the neoplasm code.
🚫 Do not use signs and symptoms codes to replace the malignancy as the principal diagnosis.
🔍 For unclear documentation on neoplasm status, query the provider for clarification.
🩱 Use Z 85 codes to indicate personal history of a malignant neoplasm if the primary malignancy has been excised or destroyed.
🔗 For complications arising from a transplanted organ and malignancy, sequence the transplant-related complication code first, followed by the malignancy code.

Q & A

What is the correct approach to coding neoplasms according to the ICD-10-CM guidelines?
-To code neoplasms, one must first consult the health record to determine if the neoplasm is malignant and whether it is a primary or secondary site. It's also important to check if the carcinoma is in situ or confined to the point of origin. The neoplasm table in the ICD-10-CM should be used to find the appropriate code, but the medical record should be checked first for any specific tissue documentation before referring to the table.
How does the ICD-10-CM system handle overlapping site boundaries for primary malignant neoplasms?
-The ICD-10-CM system provides subcategory codes for primary malignant neoplasms with overlapping site boundaries, which means the cancer is in two or more continuous sites. These situations are classified using a point eight in the subcategory code.
What is the significance of the neoplasm table's different columns?
-The different columns in the neoplasm table are crucial for accurately coding a neoplasm. They provide information on the site, behavior, and type of the neoplasm, which guides the coder to the correct code based on the health record's details.
In what situations should the neoplasm table not be the first reference for coding?
-The neoplasm table should not be the first reference if the medical record documents the type of tissue, as this term should be looked up first in the alphabetical index. The term will direct the coder to the correct table or code for the neoplasm.
How are cases with multiple neoplasms of the same site but not continuous handled in coding?
-When there are multiple neoplasms of the same site that are not continuous, such as tumors in different quadrants of the breast, a separate code for each site should be assigned to accurately reflect the distinct locations.
What is the primary diagnosis when the focus of treatment is on the malignancy?
-In cases where the treatment focus is on the malignancy, the malignancy should be assigned as the principal diagnosis.
What are the exceptions to assigning the malignancy as the principal diagnosis?
-The exceptions are when the encounter is specifically for chemotherapy, immunotherapy, or radiation therapy. In these cases, specific E-codes are sequenced first, followed by the malignancy codes as secondary diagnoses.
How is the principal diagnosis determined when the focus is on a secondary site?
-If the focus of treatment is solely on the secondary site, even if the patient has a primary malignancy, the secondary site is coded as the principal diagnosis.
What code is used to indicate a personal history of a malignant neoplasm when the primary malignancy has been excised or destroyed?
-Code category Z 85 is used to indicate the personal history of a malignant neoplasm when the primary malignancy has been excised or destroyed, and there is no evidence of additional treatment at that site.
How should complications from a surgical procedure for a neoplasm be coded?
-When a patient is treated for a complication from a surgical procedure related to a neoplasm, the complication should be the principal diagnosis, followed by the neoplasm code.
What is the correct sequencing for a patient with a malignant neoplasm who is also pregnant?
-For a pregnant woman with a malignant neoplasm, the first listed code should be from subcategory O9A.1, indicating a malignant neoplasm complicating the pregnancy. The specific neoplasm code should also be reported.

Outlines

00:00

📚 Introduction to Neoplasm Coding

This paragraph introduces the topic of coding for neoplasms as per ICD-10-CM Guidelines, specifically focusing on chapter 2 which deals with neoplasm codes C00 through D49. It emphasizes the importance of understanding the neoplasm table in the alphabetical index, and the need to determine whether a neoplasm is malignant and its primary or secondary nature. The paragraph also discusses overlapping site boundaries and the significance of proper coding in situations with multiple neoplasms or metastatic carcinomas.

05:03

🩺 Principal Diagnosis and Treatment Focus

This section delves into the rules for assigning the principal diagnosis in cases where the focus of the encounter is the malignancy. Exceptions are highlighted for encounters related to chemotherapy, immunotherapy, or radiation therapy, where specific E-codes are sequenced first. The paragraph also addresses the treatment of secondary sites, complications arising from malignancies, and the sequencing of codes in different scenarios, such as anemia associated with malignancy or therapy, and management of dehydration due to malignancy.

10:06

🏥 Post-Surgical and Complication Management

This segment discusses the coding principles for patients who have undergone surgical procedures for malignancy and those presenting with complications from such procedures. It explains the use of code category Z 85 for personal history of a malignant neoplasm when the primary malignancy has been excised, and the sequencing of codes for patients undergoing chemotherapy or radiation therapy alongside surgical removal of a neoplasm. The paragraph also touches on the coding for complications from surgical procedures and the management of dehydration due to malignancy.

15:07

🤰 Pregnancy and Neoplasms

This paragraph addresses the intricacies of coding for pregnant patients with neoplasms, emphasizing the sequencing priority of pregnancy codes. It clarifies that signs and symptoms related to malignancies cannot replace the malignancy as the principal diagnosis. The paragraph also discusses the coding for multiple non-contiguous malignancies, the use of code C80 for disseminated malignant neoplasm when no primary or secondary site is known, and the rare use of code C80.1 for malignant neoplasm without specification of the site.

20:09

🩺 Complications and Transplanted Organs

The final paragraph covers various scenarios involving complications associated with neoplasms, including the coding for pathologic fractures due to neoplasms and the distinction between current malignancy and personal history. It also discusses the coding for patients with malignant neoplasms associated with transplanted organs, highlighting the use of specific codes for complications of transplanted organs and the associated malignancies.

Mindmap

Keywords

💡Neoplasm

A neoplasm refers to the formation of a new and abnormal growth of cells, which can be either benign (non-cancerous) or malignant (cancerous). In the context of the video, the focus is on malignant neoplasms, their coding, and the guidelines for identifying and documenting their characteristics in medical records. The video emphasizes the importance of understanding whether a neoplasm is primary or secondary and its relationship to other health conditions.

💡ICD-10-CM Guidelines

The ICD-10-CM Guidelines are the standardized coding rules used in the United States for classifying and reporting diseases, symptoms, and procedures. These guidelines are crucial for healthcare professionals to accurately document and communicate patient health information. The video provides an in-depth review of these guidelines, particularly focusing on the coding of neoplasms, ensuring that healthcare providers understand how to correctly apply these codes in clinical documentation.

💡Malignancy

Malignancy refers to the presence of cancer, a disease characterized by the uncontrolled growth and spread of abnormal cells. In the video, the term is used to describe a type of neoplasm that is cancerous and poses a threat to health. Understanding the malignancy of a neoplasm is essential for proper treatment and management of the condition.

💡Primary Site

The primary site refers to the initial location in the body where a cancer originates. This is a critical piece of information in cancer diagnosis and treatment planning. In the context of the video, identifying the primary site of a malignant neoplasm is essential for accurate coding and understanding the cancer's progression.

💡Metastatic Carcinoma

Metastatic carcinoma is a term used to describe cancer that has spread from its original site to other parts of the body. This spread, known as metastasis, is a hallmark of advanced cancer. In the video, the concept of metastatic carcinoma is important for understanding the disease's stage and for coding purposes, as it affects the choice of ICD-10-CM codes.

💡Overlapping Site Boundaries

Overlapping site boundaries refer to situations where a cancer is present in two or more continuous sites within the body. This complexity in cancer location requires specific subcategory codes in the ICD-10-CM system to accurately capture the extent of the disease. The video provides guidance on how to handle such cases in medical coding.

💡Sequence of Codes

The sequence of codes refers to the order in which diagnostic and procedural codes are listed in a patient's medical record. This sequence is important as it can impact the interpretation of the patient's health status and the prioritization of treatment. The video provides detailed rules and exceptions for sequencing codes related to neoplasms and their treatment.

💡Complications

Complications are secondary conditions that arise from the primary disease or its treatment. In the context of the video, complications related to malignancies, such as anemia or pathological fractures, require specific coding to accurately reflect the patient's health status and the focus of treatment. Understanding and coding complications correctly is crucial for patient care and insurance reimbursement.

💡Personal History

Personal history in medical coding refers to a patient's past health conditions, including previous diagnoses of diseases like malignancies. When a patient has been treated for a neoplasm and the site of the malignancy has been removed or destroyed, the personal history code Z85 is used to indicate the former site of the malignancy. This is important for tracking the patient's health history and informing future care decisions.

💡Transplanted Organ Complications

Complications related to transplanted organs are health issues that arise after an organ transplant. In the context of the video, if a patient with a transplanted organ develops a malignant neoplasm as a complication, specific codes are used to document this situation. This ensures that the healthcare provider accurately captures the complexity of the patient's condition and treatment history.

Highlights

Review of ICD-10-CM Guidelines focusing on Section 1, with three parts: conventions, general coding guidelines, and specific guidelines.

Discussion on coding for infectious and parasitic diseases (Chapter 1) and transition to neoplasm codes (Chapter 2).

Importance of familiarizing oneself with the Neoplasm Table in the Alphabetical Index for proper coding of neoplasms.

Determination of whether a neoplasm is malignant and its primary or secondary nature for accurate coding.

Consideration of whether a carcinoma is in situ or confined to the point of origin for coding purposes.

Handling overlapping site boundaries in neoplasms and the use of subcategory codes for such situations.

The sequence of coding for multiple neoplasms at the same site that are not continuous.

The primary place to locate neoplasm codes is not the Neoplasm Table first, but rather the type of tissue if documented in the medical record.

Rules for sequencing codes when the focus of treatment is on the malignancy, including exceptions for chemotherapy, immunotherapy, or radiation therapy.

Treatment of secondary sites and the focus on those sites as the principal diagnosis.

Coding for complications associated with malignancy, such as anemia, and the importance of sequence in telling the story of the patient's condition.

Management of dehydration due to malignancy and the correct sequence of coding for such situations.

Use of code category Z 85 for personal history of a malignant neoplasm when the primary malignancy has been excised or destroyed.

Focus on the surgical removal of a neoplasm and the sequencing of codes for such encounters, including chemotherapy or radiation.

Scenarios involving admissions and encounters for chemotherapy, immunotherapy, and radiation therapy, and the correct sequencing of codes.

Complications arising from therapies and the sequencing of codes to accurately reflect the focus of the encounter.

Determining the extent of malignancy through diagnostic procedures and the correct coding sequence for such encounters.

The role of signs and symptoms in coding for malignancies and the limitations of using such codes as the principal diagnosis.

Coding for malignancies in multiple non-contiguous sites and the need for clarification when documentation is unclear.

Use of code C80.0 for disseminated malignant neoplasm when there is no known primary or secondary site specified.

The rare use of code C80.1 for malignant neoplasm without specification of the site in the inpatient setting.

Transcripts

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Related Tags

Neoplasm Coding ICD-10-CM Guidelines Malignant Tumors Primary vs. Secondary Cancer Treatment Medical Coding Healthcare Compliance Coding Sequencing Transplanted Organs Complication Management