ICD-10-CM Specific Coding Guidelines - (begin 21:31) Neoplasms Part TWO

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let's continue our discussion your poll

question asked you whether or not you

knew that there

were six classifications of neoplasms

when coding and you all knew that so

let's

review we have primary cancer or

malignancy this is where the cancer

origin

originates we also have secondary cancer

or

malignancy this secondary cancer results

from the primary and we call this

metastasis or it has

metastasized also we have

insitu this is a form of malignancy but

it's not always malignant just to let

you know that it can be malignant or it

may not be malignant

but this type of malany is confined to

us to the site of origin without

invading the ne neighboring tissue so

it's pretty much

contained also we have

benign the this is not a malignancy but

these are abnormal non-cancerous

cells we also have uncertain neoplasms

that means the provider can't determine

the nature of the neoplasm so they don't

know if it's malignant or not and

finally

unspecified there's insufficient

information in the medical record to

assign a specific

code these are the meanings of these

classifications and some I just want to

kind of drive

home a little bit about the nature or

the evolution of

cancer so in this um this represents the

prostate and I'm going to try and show

you how cancer evolves I'm going to try

all right so the first image represents

normal cells found within the prostate

gland the

second this is where you see the normal

cells begin to grow and multiply and

these are benign cells they're not

cancerous so we're going to call them

benign but when those benign cells

continue to grow and

multiply and they begin to damage other

cells within the prostate

gland and they

even these start becoming classified as

malignancy or they can be malignant or

they are are okay in this

exercise and this is lowgrade

malignancy now they become highgrade

when you have significant structural

damage of that gland and it's caused by

these cells becoming aggressive and look

at the mutation they've mutated into

something that could look like a

tumor right and at this stage the

Cancer's aggressive and the patient is

really

sick and if that isn't enough the

aggressive cancer cells begin to move to

other parts of the body like bone and

this is what we

call secondary cancer another word for

secondary

metastasis or the cancer has metastasi

so the first two images are benign cells

um they're uncertain cells or

unspecified

cells the next two represent primary

cancer or insitu or insitu cancer and

then the last image represents secondary

cancer and I'm finished and I'mma let

that Marin

hopefully it helps understand helps you

as a coder understand how prostate or

how cancer

evolves how normal cells

evolve better now let's get to

our icd1 CM let's take a look at

it and let's just observe the columns in

the neoplasm

table this neoplasms table is in the

index it's in the alphabetic index it's

after the guidelines it's yeah it's

after the guidelines right there and

these six

classifications are found at the top of

the um table so the First Column all of

the codes within the first

colum Cancer all of the

second secondary cancer and we also call

this cancer Mets or metastasize

or um secondary cancer then you have

your cancer in

situ

benign

uncertain and

unspecified

behavior and when your documentation

specifies the type of cancer that's

where you get your

code now let's talk a little more about

this neoplasms

table well the first thing all cancers

are not coded from this table not all

cancers but your malignancies pretty

much are the types of cancers that are

not coated using this table are

typically your om your

saroma lipoma that's not necessarily a

cancer but it could be

neoplasma also adoma

carcinoma they are not from this

chart or table but where can you find

it of course you can find it in the

alphabetic

index so you may say well don't we go to

the alphabetic index first

anyway

right not for neoplasms you can go right

to the neoplasms table and then verify

in the tabular

list I'mma say it again you can go right

to the neoplasms table look up your code

then verify it in the tabular

list all right coders I'm a lot and I

want to know how you're doing you're

doing

good people say they're doing great okay

another thing I want to tell you about

these um columns the first three are

cancerous cancer and situ um can be

cancerous or or not so we're going to

put it in the cancerous um section and

the last three are not cancerous they're

not considered

cancerous now let's go ahead and let's

code together using this neoplasms

table all

right a patient arrives to the

oncologist to receive treatment for

prostate

cancer all right I got a question which

cancer are we coding

for well it's pretty obvious right we

only have one cancer and that's prostate

cancer and this prostate cancer it

defaults to primary when you're coding

for the exam if there's no mention

that this is secondary cancer the

default is

primary all right so let's go look up

this code all right so the patient

arrives for prostate cancer so we know

this is primary so our code is going to

we're going to take our code from the

First Column but I do want to point out

that these cancers these neoplasms are

arranged

alphabetically so you just pretty much

look for your cancer in alphabetical

order so we're going to go down until we

get to the P's and we find prostate

cancer um c um

CC1 c61 c79 D7 etc etc but where we find

our code we just make sure we're in the

correct column we know this is primary

so we're going to look in the primary

column and you can see what the answer

is so we've seen that c61 is our code

let's go ahead and

verify so when we look in the tabular

list c61 malignant neoplasm of

prostate and it tells you to use

additional code

if applicable to identify the hormone

sensitivity

status and Rising PSA following

treatment for malignant neoplasm of

prostate so this is inapplicable our