Neoplasm Table in ICD-10-CM

Understanding the Neoplasm Table

The Neoplasm Table is a critical resource for coding neoplasms (tumors, cancers) in ICD-10-CM. It is divided into two main columns:

• Column 1: Contains the morphology or site (type of cancer or location).

• Column 2: Specifies the behavior of the neoplasm (benign, malignant, in situ, or uncertain behavior).

Key Steps for Using the Neoplasm Table

• Step 1: Look up the Neoplasm by its Site

  • You begin by identifying the site of the neoplasm (e.g., lung, breast, colon).

  • The Neoplasm Table will guide you to the correct location and match the site with a code.

• Step 2: Identify the Morphology

  • The morphology refers to the specific type of neoplasm (e.g., carcinoma, sarcoma).

  • In ICD-10-CM, each neoplasm has a unique code depending on its tissue type.

• Step 3: Determine the Behavior

  • The Neoplasm Table will list different behavior codes, such as:

    • Benign (0)

    • Malignant (3)

    • Carcinoma in situ (2)

    • Uncertain behavior (1)

  • Choose the appropriate behavior code based on the documentation provided by the physician.

• Step 4: Review the Excludes Notes

  • The Neoplasm Table has specific “Excludes” notes for certain neoplasms, which indicate when certain codes cannot be used together.

Common Tips for ICD-10-CM Neoplasm Coding

• Use the Alphabetical Index First
  Before diving into the Neoplasm Table, always search for the neoplasm in the Alphabetical Index first. This will provide you with the proper code range or site, and the Neoplasm Table will give you more detail.

• Malignant Neoplasms:

  • Malignant neoplasms are the most common type of cancer. They are often the easiest to code because the Neoplasm Table clearly lists malignant neoplasms under each body system.

  • Remember to code for primary cancers (originating in a specific site) separately from secondary or metastatic cancers (cancer that has spread from the original site).

• Carcinoma in Situ (CIS):

  • Carcinoma in situ is a term used to describe cancers that have not spread beyond the original location. In ICD-10-CM, these tumors are often listed separately, and the behavior code for CIS is 2.

  • For example, a code for Cervical Carcinoma in Situ is D06.

• Benign Neoplasms:

  • Benign neoplasms are usually non-cancerous and don’t spread to other parts of the body. The behavior code for benign neoplasms is 0.

  • Example: A benign skin tumor might be coded as D23.

• Avoid Using Neoplasm Codes for Unspecified Neoplasms:

  • If the type of neoplasm is unspecified, do not use the unspecified codes unless you cannot find any other information in the clinical documentation. Always try to get as specific a code as possible.

• Coding for Metastasis:

  • If a neoplasm is metastatic (cancer has spread from its primary site), you should use the code for the site of the metastasis, not the original location.

  • For example, a metastatic lung cancer found in the liver should be coded as C78.7 (secondary malignant neoplasm of liver), not as C34 (lung cancer).

• Use of Modifiers:

  • If the neoplasm is described as being recurrent, use the proper modifier to indicate its recurrence. This is important for capturing the clinical severity accurately.

Guidelines for Special Cases:

• Multiple Neoplasms:

  • If a patient has multiple neoplasms at different sites, you may need to report multiple codes, one for each site.

  • Example: A patient with both breast cancer and lung cancer would need two codes, one for each site.

• Neoplasms of the Same Site, Different Histologies:

  • If two different histologic types of neoplasms are identified at the same site, both should be coded. However, if the documentation indicates a combination neoplasm (e.g., adenocarcinoma and squamous cell carcinoma at the same site), a combination code should be used, if available.

• Neoplasms of Unspecified Behavior:

  • Sometimes, a neoplasm may be described as “unspecified” or with uncertain behavior. In this case, select the appropriate code for unspecified neoplasms when the behavior is not documented clearly. You should strive to clarify this with the provider when possible.

Keep Current With Updates

• ICD-10-CM codes and guidelines are updated annually. It’s essential to check for any revisions in the Official Coding Guidelines and the ICD-10-CM codebook to stay on top of any new classifications, especially with advances in medical terminology and cancer research.

Document Thoroughly

• Always ensure that the physician’s documentation is as complete and accurate as possible, especially regarding the specific type, location, and behavior of the neoplasm. Accurate and thorough documentation can significantly reduce coding errors and denials.

Coding for Secondary Neoplasms

Secondary neoplasms are coded separately from primary cancers. When coding for secondary or metastatic cancers:

• Always use the secondary cancer code for the site where the cancer has spread.

• Avoid coding the primary neoplasm again if it’s not directly relevant to the metastatic site.

By following these guidelines, you can confidently navigate the ICD-10-CM Neoplasm Table and code neoplasms accurately. Ensure that you stay up-to-date with the latest coding manuals, and always prioritize complete and precise clinical documentation!

Primary vs Secondary Diagnosis in Medical Coding. https://codingclarified.com/medical-coding-primary-vs-secondary-diagnosis/ 

The SEER Training Website is a training resource for oncology data specialists (ODS) and cancer registration trainees https://training.seer.cancer.gov/icd10cm/neoplasm/