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Coding tip: Be aware of primary versus secondary neoplasms

Ambulatory Surgery Reimbursement Update, September 18, 2007

There are certain neoplasms that you should automatically assume are secondary (metastatic) neoplasms, unless the CPT Manual indicates otherwise.

These sites include the bone, brain, meninges, peritoneum, pleura, spinal cord and retroperitoneum. If the diagnosis in the operative report states "metastatic colon cancer," this usually means that the colon is the primary site and the cancer has metastasized to other locations.

Unless you know where the cancer has traveled to, use diagnosis code 199.0 for metastasis to unknown (single or multiple) site(s). Wait until the pathology report comes back prior to coding these claims, so the coder can use the exact diagnosis for correct coding of the neoplasm.

Additional terms for neoplasms include: malignant, primary site, secondary site, ca. in-situ, benign, uncertain behavior and unspecified nature. If a physician treats a patient for a primary malignancy, then the coder should code that malignancy first.

If the physician treats the patient for a secondary (or metastatic) neoplasm, then the physician would designate the secondary neoplasm as the principal diagnosis, even if the primary site is still active.

If the physician is treating the patient for something other than an active neoplasm (and the patient is thought to be "in remission"), the coder should use the personal history V10.X codes. Personal history codes explain a patient's past medical condition that no longer exists, and that he or she is no longer receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.

This tip is brought to you by Ellis Medical Consulting, Inc.

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