EmailComplication of primary neoplasm or neoplasm treatment
Publication Date: September 2021
Implementation Date: 1/10/2021
ICD 10 AM Edition: Eleventh Edition
Retired Date: 31/5/2023
Query Number: 3608
The Western Australian Clinical Coding Authority has released a Coding Guideline: Guide to Major Eleventh Edition Changes. This guideline states the following:
Primary neoplasm is automatically coded in an episode involving treatment of complications of the primary neoplasm or neoplasm treatment i.e. the neoplasm itself does not need to meet ACS 0002 Additional diagnoses. See Example 11 in ACS 0002 Additional diagnoses. Primary neoplasm is automatically coded in an episode for management of a complication of neoplasm surgical site, such as wound infection or haematoma following recent surgery. However, concern has been raised about late complications of neoplasm treatment such as cystitis/proctitis/osteonecrosis due to radiotherapy, where the primary neoplasm has been cured and is no longer current. This issue will be raised with the Independent Hospital Pricing Authority (IHPA). In the meantime, do not code cured primary neoplasm as a current condition in these circumstances.
Can VICC please advise if a neoplasm code should be assigned in episodes where the patient is admitted for ‘late’ complications of the neoplasm treatment such as: Radiation enteritis, Radiation fibrosis, Osteonecrosis, Incontinence (either due to radiotherapy or surgery such as prostatectomy for neoplasm), Cystitis, Proctitis?
Primary neoplasm is automatically coded in an episode involving treatment of complications of the primary neoplasm or neoplasm treatment i.e. the neoplasm itself does not need to meet ACS 0002 Additional diagnoses. See Example 11 in ACS 0002 Additional diagnoses. Primary neoplasm is automatically coded in an episode for management of a complication of neoplasm surgical site, such as wound infection or haematoma following recent surgery. However, concern has been raised about late complications of neoplasm treatment such as cystitis/proctitis/osteonecrosis due to radiotherapy, where the primary neoplasm has been cured and is no longer current. This issue will be raised with the Independent Hospital Pricing Authority (IHPA). In the meantime, do not code cured primary neoplasm as a current condition in these circumstances.
Can VICC please advise if a neoplasm code should be assigned in episodes where the patient is admitted for ‘late’ complications of the neoplasm treatment such as: Radiation enteritis, Radiation fibrosis, Osteonecrosis, Incontinence (either due to radiotherapy or surgery such as prostatectomy for neoplasm), Cystitis, Proctitis?
Response
VICC referred this query to IHPA who provided the following response:
ACS 0236 Neoplasm coding and sequencing/Primary neoplasm as a current condition states:
A primary neoplasm is classified as a current condition if the episode of care is for:
• diagnosis or treatment of the primary neoplasm, in any of the following circumstances:
- initial diagnosis of the primary neoplasm
- treatment of complications of the primary neoplasm or neoplasm treatment
- operative intervention to remove the primary neoplasm
- medical care related to the primary neoplasm, including palliative care (see also ACS 2116 Palliative care)
- recurrence of the primary neoplasm previously eradicated from the same organ or tissue (see also ACS 0237 Recurrence of malignancy)
…
If the episode of care is for treatment of another nonmalignant condition, the malignancy may be classified as a current condition only if it meets the criteria for code assignment as per ACS 0002 Additional diagnoses.
The term ‘neoplasm treatment’ in ACS 0236 (above) relates to interventions specifically targeting the neoplasm, such as pharmacotherapy or radiotherapy. Complications of surgical interventions performed for treatment of a neoplasm are assigned in accordance with the guidelines in ACS 1904 Procedural complications.
Therefore, a primary neoplasm code is assigned in an episode of care when there is treatment of a primary neoplasm, neoplasm related condition, or a pharmacotherapy or radiotherapy related complication.
When a nonmalignant condition is the principal diagnosis in an episode of care, a primary neoplasm code is assigned as an additional diagnosis when:
• it meets the criteria in ACS 0002 Additional diagnoses; or
• a neoplasm related condition, or pharmacotherapy or radiotherapy related complication, meets the criteria in ACS 0002 Additional diagnoses.
Where documentation confirms a neoplasm is completely resolved and none of the above points applies, and the history is relevant to the current episode of care, assign a code from category Z85 Personal history of malignant neoplasm.
[End of IHPA response].
VICC notes IHPA published this response as IHPA Coding Rule Q3498 Clarification of ACS 0236 Neoplasm coding and sequencing for implementation 01 January 2021.
VICC interprets the IHPA response to mean that where there is a complication of ‘neoplasm treatment’, the cancer is coded as a current condition. This is regardless of the timeframe or whether the cancer is considered ‘cured’. However, this excludes complications of a surgical intervention as a complication of a surgical intervention for a neoplasm is not considered a complication of ‘neoplasm treatment’. Therefore the primary neoplasm is not coded unless it meets ACS 0001 Principal diagnosis or ACS 0002 Additional diagnoses and another dot point of ACS 0236 Neoplasm coding and sequencing.
Example 1:
Principal diagnosis - radiation-induced cystitis (documented as a complication of previous radiotherapy for cured prostate cancer)
Additional diagnosis – prostate primary neoplasm as the radiation-induced cystitis is a ‘radiotherapy related complication’ that meets the criteria in ACS 0236 Neoplasm coding and sequencing for coding of the neoplasm.
Example 2:
Principal diagnosis - Incontinence due to radiotherapy for prostate neoplasm
Additional diagnosis – prostate primary neoplasm as the incontinence is a ‘radiotherapy related complication’ that meets the criteria in ACS 0236 Neoplasm coding and sequencing for coding of the neoplasm.
Example 3:
Principal diagnosis – Incontinence due to prostatectomy for prostate neoplasm
Prostate primary neoplasm is not coded as an additional diagnosis as incontinence is a surgical complication in this example (unless the cancer meets ACS 0002 Additional diagnoses in its own right).
Note: VICC has published this response because the committee has added further information to the IHPA Coding Rule response. This information does not alter the IHPA Coding Rule.
[end of VICC response].
Note: This query has been retired following Twelfth Edition amendments to ACS 0236 Neoplasm coding and sequencing and the retirement of Q3498 Clarification of ACS 0236 Neoplasm coding and sequencing.
ACS 0236 Neoplasm coding and sequencing/Primary neoplasm as a current condition states:
A primary neoplasm is classified as a current condition if the episode of care is for:
• diagnosis or treatment of the primary neoplasm, in any of the following circumstances:
- initial diagnosis of the primary neoplasm
- treatment of complications of the primary neoplasm or neoplasm treatment
- operative intervention to remove the primary neoplasm
- medical care related to the primary neoplasm, including palliative care (see also ACS 2116 Palliative care)
- recurrence of the primary neoplasm previously eradicated from the same organ or tissue (see also ACS 0237 Recurrence of malignancy)
…
If the episode of care is for treatment of another nonmalignant condition, the malignancy may be classified as a current condition only if it meets the criteria for code assignment as per ACS 0002 Additional diagnoses.
The term ‘neoplasm treatment’ in ACS 0236 (above) relates to interventions specifically targeting the neoplasm, such as pharmacotherapy or radiotherapy. Complications of surgical interventions performed for treatment of a neoplasm are assigned in accordance with the guidelines in ACS 1904 Procedural complications.
Therefore, a primary neoplasm code is assigned in an episode of care when there is treatment of a primary neoplasm, neoplasm related condition, or a pharmacotherapy or radiotherapy related complication.
When a nonmalignant condition is the principal diagnosis in an episode of care, a primary neoplasm code is assigned as an additional diagnosis when:
• it meets the criteria in ACS 0002 Additional diagnoses; or
• a neoplasm related condition, or pharmacotherapy or radiotherapy related complication, meets the criteria in ACS 0002 Additional diagnoses.
Where documentation confirms a neoplasm is completely resolved and none of the above points applies, and the history is relevant to the current episode of care, assign a code from category Z85 Personal history of malignant neoplasm.
[End of IHPA response].
VICC notes IHPA published this response as IHPA Coding Rule Q3498 Clarification of ACS 0236 Neoplasm coding and sequencing for implementation 01 January 2021.
VICC interprets the IHPA response to mean that where there is a complication of ‘neoplasm treatment’, the cancer is coded as a current condition. This is regardless of the timeframe or whether the cancer is considered ‘cured’. However, this excludes complications of a surgical intervention as a complication of a surgical intervention for a neoplasm is not considered a complication of ‘neoplasm treatment’. Therefore the primary neoplasm is not coded unless it meets ACS 0001 Principal diagnosis or ACS 0002 Additional diagnoses and another dot point of ACS 0236 Neoplasm coding and sequencing.
Example 1:
Principal diagnosis - radiation-induced cystitis (documented as a complication of previous radiotherapy for cured prostate cancer)
Additional diagnosis – prostate primary neoplasm as the radiation-induced cystitis is a ‘radiotherapy related complication’ that meets the criteria in ACS 0236 Neoplasm coding and sequencing for coding of the neoplasm.
Example 2:
Principal diagnosis - Incontinence due to radiotherapy for prostate neoplasm
Additional diagnosis – prostate primary neoplasm as the incontinence is a ‘radiotherapy related complication’ that meets the criteria in ACS 0236 Neoplasm coding and sequencing for coding of the neoplasm.
Example 3:
Principal diagnosis – Incontinence due to prostatectomy for prostate neoplasm
Prostate primary neoplasm is not coded as an additional diagnosis as incontinence is a surgical complication in this example (unless the cancer meets ACS 0002 Additional diagnoses in its own right).
Note: VICC has published this response because the committee has added further information to the IHPA Coding Rule response. This information does not alter the IHPA Coding Rule.
[end of VICC response].
Note: This query has been retired following Twelfth Edition amendments to ACS 0236 Neoplasm coding and sequencing and the retirement of Q3498 Clarification of ACS 0236 Neoplasm coding and sequencing.
