Classification of Neoplasms

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3 Classification of Neoplasms ICD-10 Chapter 2, Neoplasms Codes C00-D48 Notes at beginning of Chapter 2 Classified by behaviour and site Correct use of Alphabetic index required Main terms Modifiers Table of neoplasms All codes must be verified in the Tabular index 5 steps to accurate coding

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6 Example, If lung cancer spreads to the liver, the cancer cells in the liver are lung cancer cells. The disease is called metastatic lung cancer (it is not liver cancer). Primary Site= Lung Secondary site= Liver

7 /0/1 The second edition of the International Classification of Diseases for Oncology (ICD-O) was published in It contains a coded nomenclature for the morphology of neoplasms See Note.8 at beginning of Chapter 2 Look Up Carcinoma, Hepatic Cell Carcinoma - - hepatic cell (M8170/3) C22.0 ICD-O Morphology Code ICD-10 Code

8 The Histology Report

9 General Hospital Regional Histopathology Laboratory Name Addr Lab: Cons: DoB Sex: Hosp: Chart Ward: Date recd: Nature of specimen: Skin lesion excised from left shoulder GROSS EXAMINATION: Skin 0.8cm with pale brown nodule 0.5cm MICROSCOPIC EXAMINATION: Skin with a spindle cell compound naevus (Spitz naevus). The lesion is completely excised and there is no evidence of malignancy. Dr. K Cunnandel Pathologist 21/08/2005

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12 Look up main term Follow instructions given at alphabetic index entry. Instructed to go to Table of Neoplasms Example : Ewings Sarcoma - Ewing's (M9260/3) see Neoplasm, bone, malignant OR Code may be provided at the main term (no need to go to Table of Neoplasms) Example : Adenoma, bile duct Adenoma - bile duct (M8160/0) D13.4

13 Identify Main term and any modifiers Example: Sarcoma, meningeal Sarcoma - meningeal (M9530/3) see Neoplasm, meninges,malignant Go to Neoplasm, Table of neoplasms Table Ordered by Site = Meninges And Behaviour =Malignant C70.9 Malignant Neoplasm Meninges, unspecified

14 !"##$%&'( Malignant Site Primary Secondary In situ Benign Uncertain or unknown behaviour Neoplasm C80 C80 D09.9 D36.9 D48.9

15 !"##$%&'( The Table of Neoplasms (see extract below) Malignant Uncertain Primary Secondary In situ Benign Unknown --abdominopelvic C76.8 C79.88 D36.7 D accessory sinus see Neoplasm, sinus --acromion (process) C40.0 C79.5 D16.0 D adenoid (tissue) C11.1 C79.88 D00.0 D10.6 D adipose tissue see Neoplasm, connective tissue -adnexa (uterine) C57.4 C79.82 D07.3 D28.7 D39.7

16 Summary!"% 3( 3 "" "$ 3:" If a code is provided at the alphabetic index entry, assign the code provided and do not go to the Table of Neoplasms

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23 Coding Solid Tumours Metastatic Cancer/ Secondary cancer Example: Carcinoma of the breast with bone secondaries Type of neoplasm = carcinoma Site of primary Secondaries Classification= = breast = secondaries of the bone C50.9 Malignant neoplasm of breast, unspecified C79.5 Secondary malignant neoplasm of bone & bone marrow

24 2 ** Alphabetic index multiple entries for metastatic cancer e.g. carcinoma, metastatic - metastatic (M8010/6) see Neoplasm, secondary - Table of Neoplasms, use column Secondary -., *3 *. *, - C80 is assigned if secondary site/s is unknown Example :Primary carcinoma of breast with 2. *. 2.*. $*3%

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26 Coding Solid Tumours Metastatic Cancer If two or more sites are stated in the diagnosis and all are described as metastatic and none as primary, code as for 'primary site unknown' and code the stated sites as secondary neoplasms of the stated sites. Look up Neoplasm, unknown, unspecified C80 Malignant neoplasm without specification of site Unknown Primary = C80

27 C80 Malignant neoplasm without specification of site Cancer } Carcinoma } Carcinomatosis } Generalized: } unspecified site (primary)(secondary) cancer } malignancy } Malignancy } Multiple cancer } Malignant cachexia Primary site unknown

28 Coding Solid Tumours Metastatic Cancer The sequencing of either primary or secondary malignancy code depends on the treatment at each episode. Definition of principal diagnoses applies: A neoplasm, whether primary or metastatic, that is the focus of care during a relevant episode of health care, should be recorded and coded as the main condition. Extracted from ICD-10 Second Edition, 2005, 4. Rules and guidelines for mortality and morbidity coding.

29 Non-Solid Tumours C81 C96 Lymphatic and haematopoietic neoplasms differ from solid neoplasms in several ways including; Cells often circulate in large numbers in the bloodstream and the lymphatic system rather then remaining confined to a specific site. These additional sites are not considered to be secondary but are classified as primary neoplasms. Code to specified type of lymphoma

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31 Non-Solid Tumours C81 C96 Multiple Myeloma and Leukaemia Exercise: Patient diagnosed with acute lymphocytic leukaemia Main Term: Check if modifiers present: Verify code in Tabular index:

32 Non-Solid Tumours C81 C96 Multiple Myeloma and Leukaemia Exercise: acute lymphocytic leukaemia Alphabetic index entry: Leukaemia Check if modifiers present: Lymphocytic & Acute Leukaemia - lymphocytic (M9820/3) C acute (M9821/3) C91.0 Verify code C91.0 in Tabular index Acute Lymphocytic Leukaemia= Assign code C91.0

33 Coding of Non Solid Tumours Summary C81 C96 Malignant neoplasms of lymphoid, haematopoietic and related tissue Non Solid Tumours classified by disease e.g. lymphoma, leukaemia Look up main term in alphabetic index e.g. lymphoma Verify code given in Alphabetic index in the Tabular index

34 Anaemia in neoplastic disease (D63.0*) Code D63.0* Anaemia in neoplastic disease should be assigned when anaemia occurs in, due to or with a neoplastic condition. Look Up: Anaemia in neoplastic disease NEC (see also Neoplasm) D48.9 D63.0* This allows for a specific code for the neoplasm to be assigned with the manifestation code of D63.0*. Dagger/asterisk sequencing

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36 6 Guideline required for when a secondary neoplasm is being treated and the primary neoplasm has been previously resected ICD-10 Code to the current condition such as secondary neoplasm and a Personal History code for the resected primary ICD-10-AM the primary malignancy should be coded as an additional diagnosis.

37 ' Example : Patient admitted for treatment of metastatic carcinoma of liver. Primary carcinoma of the sigmoid colon had been resected 12 months previously and there has been no recurrence. ICD-10-AM Codes: C78.7 Secondary malignant neoplasm of liver C18.7 Malignant neoplasm of colon, sigmoid colon ICD-10 Codes C78.7 Secondary malignant neoplasm of liver Z85.0 Personal history of malignant neoplasm of digestive organs

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39 Summary of ICD-10 Guidelines for Coding Neoplasms See Notes provided in ICD-10 Chapter II Tabular Index Note 1: Note 2. Note 3. Note 4. Note 5. Primary, ill-defined, secondary and unspecified sites of malignant neoplasms Functional activity Morphology Use of subcategories in Chapter II Malignant neoplasms overlapping site boundaries and the use of subcategory.8 (overlapping lesion)

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