Malignant tumor invasion/infiltration

dallend@einstein.edu

HI,
I have a question. One of our coders requested a query for a chart with the following scenario:
70 Yr old female admitted with pain. + malignant neoplasm of vagina. Per progress notes Oncology stated "tumor invading rectum and bladder", "Invasion of tumor involving rectum and bladder".

Coding requesting clarification mets vs tumor growth.

MD queried - noted that this was not mets - this was tumor invasion to bladder and rectum. Pt was placed on Hospice. Pain was due to tumor invasion.

There were no biopsies, etc performed. Diagnosis based on results of CT scan.

How do you code the secondary sites - bladder and rectum. I was thinking you would use the codes for secondary malignant neoplasm - 197.5 and 198.1. Seems to be a hot topic of discussion.
I tried to put the case in the encoder and my only feasible option was mets (per MD this is not appropriate).

I would be interested to hear what everyone thinks,

Thanks,
Debby Dallen,RN
Clinical Documentation Coordinator
Albert Einstein Medical Center
Philadelphia, PA 19141

gwojo

Debbie,

I have never run across this; will be interesting reading the responses. Do you have a Tumor Registrar as a resource?



Francisca Wojciechowski BS, RHIA, RHIT, CCDS

AHIMA-Approved ICD-10-CM/PCS Trainer

dallend@einstein.edu

We do have someone - it just seems that when you need them they are difficult to reach. I am going to try to catch one of our oncologist too. I thought I would get a quicker response here.
Debby

ssalinas

If the primary is no longer present, neoplasm coding guidelines direct you to code the site of the invasion or extension as a secondary site. It is not specifically addressed (that I am aware of) when the primary is still present. I have a question into 3M regarding this.

If the physician had not been queried, I probably would have coded the rectum and bladder as mets. Was there any treatment/diagnostic tests directed towards the cancer? What was being considered as the principal diagnosis? Was the admission for pain control? If so, might want to use the Neoplasm related pain code (338.3) as the principal if the palliative care came in later in the stay.

Will update when I hear what 3M has to say with the primary still being present.

Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336

evanspx@sutterhealth.org

Invasion from any primary site is always coded as mets.. Per the coding guidelines, which I can't access at the moment, (I am on vacation) this is coded as metastasis. A direct growth of malignant neoplasm to a contiguous and separate site IS metastasis. This is not 'distant' mets via the blood or lymph system, but a direct growth from one primary site, the vagina, to the rectum and bladder.

Paul Evans, RHIA, CCDS

ddouthit

Per Paul previous post...see coding guideline below:


ICD-9-CM Official Guidelines for Coding and Reporting
Effective October 1, 2011
Page 25 of 107

Primary malignancy previously excised
When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and
there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code.

Dorie Douthit, RHIT,CCS

evanspx@sutterhealth.org

Thanks, but I am referring to the question regarding the MD statement cited: "there is no mets" - this is contradictory to the information cited in the question as clearly there IS direct metastais from the vaginal to two distinct anatomical sites.


I agree the decision regarding the presence of the primary site is difficult if as it can be difficult to discern if the original site has been 'eradicated' by any methodology.


As ALWAYS, I would not venture any firm and final coding advice w/o the entire record....but my point is there IS mets present in this case per the original question.

Excuse typos ---on vacation.

Paul Evans, RHIA, CCDS, CCS, CCS-P

evanspx@sutterhealth.org

Dorie: Thanks for providing the Official Citation not available to me from home - we agree on the presence of metastasis for this case, it seems. (I believe physicians are often not aware of specific 'coding rules' and the MD seems to be indicationg there is not 'distant' mets for this case, but again, clearly a direct extension IS mets). I would 100% code the met sites for this case.

Best - Paul