Coder Q&A with Pat Macc: Metastatic Cancer
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
Some of the record documentation:
68 y.o. female with PMH of asthma, HTN, DM, PE, and metastatic ovarian cancer presented to the ED with a few days of worsening shortness of breath. Patient has known history of malignant pleural effusions, s/p talc pleurodesis of left lung. She reports that she feels like she needs the fluid removed. Currently 98-100% on RA. Denies fevers at home. Reports cough with white and yellow stringy sputum. She presented hoping she could get the fluid removed today. She also endorses chronic abdominal pain, difficulty ambulating, and nausea and vomiting. Patient received C3D1 of carbo/Abraxane on 5/26/19. CXR on admission showing right pleural effusion with mild left effusion. Patient found to be neutropenic. Admitted for work up of SOB.
Bilateral pleural effusions, right greater than left, with streaky densities in
the lower lungs representing atelectasis, pneumonia, or other airspace disease.
Impression and Plan
Impression: 68 yo female with PMH of asthma, HTN, PE, and metastatic ovarian cancer presented to the ED with a few days of worsening shortness of breath.
– R>L pleural effusion
– Hx of left lung talc pleurodesis, last thora R lung 4/22 and 1.4L removed
– Patient not candidate for pleurx
– IP consulted, plan for CT placement tomorrow R lung with probable talc pleurodesis
– NPO a MN, PT/INR ordered
– Continue Advair, ipratropium, PRN albuterol nebs
– Denies fevers at home
– Chemotherapy on 5/26
– BCx2 ordered, UCx ordered
– CBC and auto diff qday
– Start antibiotics with fevers
Metastatic ovarian cancer
– C3D1 Carbo/Abraxane 5/21
– Lymphangitic carcinomatosis of lungs with mediastinal LNs
– Chronic, likely secondary to peritoneal mets
– US para ordered, last para 4/29 and 1.1L removed
– Not on meds at home
– Continue to monitor
From what I am finding, the carcinoma has spread throughout the lymphatic vessels of the lung. Since it is of the lymphatics, and not the lung proper, I would assign C77.1, secondary and unspecified malignant neoplasm of intrathoracic lymph nodes for the lymphangitic carcinomatosis of the lung.
If you look at the neoplasm table in the ICD-10-CM book under Neoplasm, Lymph, lymphatic channel, NEC, for intrathoracic, it leads to code C77.1.
Per the following website of the National Cancer Institute, , this is the definition of lymphangitic carcinomatosis: cancer.gov/publications/dictionaries/cancer-terms/def/lymphangitic-carcinomatosis
A condition in which cancer cells spread from the original (primary) tumor and invade lymph vessels (thin tubes that carry lymph and white blood cells through the body’s lymph system). The invaded lymph vessels then fill up with cancer cells and become blocked. Although lymphangitic carcinomatosis can occur anywhere in the body, it commonly happens in the lungs. It can happen in many types of cancer but is most common in breast, lung, colon, stomach, pancreatic, and prostate cancer. Also called carcinomatous lymphangitis.
The other diagnoses within the medical record would also be coded.
We know that every case is unique. The above post is simply our opinion based on the information we have received. We encourage readers to research subsequent official guidance in the areas associated with this topic as they can change rapidly.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
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In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
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In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
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We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
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