Coder Q&A with Pat Macc: Metastatic Cancer
Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
Question:
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.
IMPRESSION:
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.
Plan:
SOB
– 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
Neutropenia
– 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
Abdominal pain
– Chronic, likely secondary to peritoneal mets
– US para ordered, last para 4/29 and 1.1L removed
HTN
– Not on meds at home
– Continue to monitor
Answer:
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
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.
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