EmailACS 0236 Neoplasm coding and sequencing
Publication Date: February 2004
ICD 10 AM Edition: Third edition
Retired Date: 30/6/2010
Query Number: 1958
The primary malignancy should be coded as a current condition if the episode of care is for:
• diagnosis or treatment of the primary malignancy, in any of the following circumstances:
- initial diagnosis of the primary malignancy
- treatment of complications of the malignancy (see also ACS 0207 Complications associated with neoplasms)
- operative intervention to remove the malignancy
- medical care related to the malignancy, including palliative care (see also ACS 0224 Palliative care)
- recurrence of a primary malignancy previously eradicated from the same organ or tissue
1. When a patient is admitted to hospital with a diagnosis of “vomiting and dehydration due to chemotherapy” received 2 days prior, does the neoplasm for which they are receiving chemotherapy meet the definition of “medical care related to the malignancy” for assignment as an additional diagnosis?
2. Similarly, when a patient is admitted for insertion of a port [for subsequent administration of chemotherapy to treat their neoplasm], or for flushing of their port, does the neoplasm for which they are receiving the port/flush meet the definition of “medical care related to the malignancy”?
The malignancy in these cases does not meet any of the criteria listed under ACS 0002 Additional Diagnoses.
However, there are differing views amongst coders regarding the definition of “medical care related to the malignancy”. There is a view that if the patient did not have the malignancy, they would not be receiving chemotherapy that caused the vomiting and dehydration and subsequent admission to hospital. A similar argument is raised in relation to admission for insertion of port or flushing of port.
I would appreciate the Committee’s opinion regarding “medical care related to the malignancy” with a response to the 2 questions above.
• diagnosis or treatment of the primary malignancy, in any of the following circumstances:
- initial diagnosis of the primary malignancy
- treatment of complications of the malignancy (see also ACS 0207 Complications associated with neoplasms)
- operative intervention to remove the malignancy
- medical care related to the malignancy, including palliative care (see also ACS 0224 Palliative care)
- recurrence of a primary malignancy previously eradicated from the same organ or tissue
1. When a patient is admitted to hospital with a diagnosis of “vomiting and dehydration due to chemotherapy” received 2 days prior, does the neoplasm for which they are receiving chemotherapy meet the definition of “medical care related to the malignancy” for assignment as an additional diagnosis?
2. Similarly, when a patient is admitted for insertion of a port [for subsequent administration of chemotherapy to treat their neoplasm], or for flushing of their port, does the neoplasm for which they are receiving the port/flush meet the definition of “medical care related to the malignancy”?
The malignancy in these cases does not meet any of the criteria listed under ACS 0002 Additional Diagnoses.
However, there are differing views amongst coders regarding the definition of “medical care related to the malignancy”. There is a view that if the patient did not have the malignancy, they would not be receiving chemotherapy that caused the vomiting and dehydration and subsequent admission to hospital. A similar argument is raised in relation to admission for insertion of port or flushing of port.
I would appreciate the Committee’s opinion regarding “medical care related to the malignancy” with a response to the 2 questions above.
Response
This query relates to the interpretation of the phrase 'medical care related to the malignancy' in ACS 0236 Neoplasm coding and sequencing.
This standard is not included in the list in ACS 0002 Additional Diagnoses as one in which coders are instructed to code conditions which do not meet the additional diagnoses criteria.
The Committee believes that the use of the term 'current condition' in ACS 0236 refers to the malignancy being coded from Volume 1 Chapter II (a 'C' code), rather than from Volume 1 Chapter XXI (a 'Z' code for 'history of').
Answers 1 & 2:
In both scenarios, the neoplasm should not be coded, as it does not meet the criteria described in ACS 0002 Additional Diagnoses.
This standard is not included in the list in ACS 0002 Additional Diagnoses as one in which coders are instructed to code conditions which do not meet the additional diagnoses criteria.
The Committee believes that the use of the term 'current condition' in ACS 0236 refers to the malignancy being coded from Volume 1 Chapter II (a 'C' code), rather than from Volume 1 Chapter XXI (a 'Z' code for 'history of').
Answers 1 & 2:
In both scenarios, the neoplasm should not be coded, as it does not meet the criteria described in ACS 0002 Additional Diagnoses.
