Chapter 2: Neoplasms - The ICD-10 Solution

Chapter 2: N

ICD-9-CM-Guideline

Primary malignant neoplasms overlapping site
boundaries
None Listed

Malignant neoplasm of ectopic tissue
None Listed

Neoplasms

ICD-10-CM - Guideline

GENERAL GUIDELINES:
Primary malignant neoplasms overlapping site
boundaries

A primary malignant neoplasm that overlaps two or
more contiguous (next to each other) sites should be
classified to the subcategory/code .8 ('overlapping
lesion'), unless the combination is specifically indexed
elsewhere. For multiple neoplasms of the same site
that are not contiguous such as tumors in different
quadrants of the same breast, codes for each site
should be assigned.

Malignant neoplasm of ectopic tissue

Malignant neoplasms of ectopic tissue are to be
coded to the site mentioned, e.g., ectopic pancreatic
malignant neoplasms are coded to pancreas,
unspecified (C25.9).

Chapter 2: N

Anemia Associated

ICD-9-CM-Guideline

Anemia associated with malignancy

When admission/encounter is for management
of an anemia associated with the malignancy,
and the treatment is only for anemia, the
appropriate anemia code (such as code 285.22,
Anemia in neoplastic disease) is designated as
the principal diagnosis and is followed by the
appropriate code(s) for the malignancy.

Code 285.22 may also be used as a secondary
code if the patient suffers from anemia and is
being treated for the malignancy.

If anemia in neoplastic disease and anemia due
to antineoplastic chemotherapy are both
documented, assign codes for both conditions.

Neoplasms

d with Malignancy

ICD-10-CM - Guideline

c. 1. Anemia associated with malignancy

When admission/encounter is for management
of an anemia associated with the malignancy,
and the treatment is only for anemia, the
appropriate code for the malignancy is
sequenced as the principal or first-listed
diagnosis followed by the appropriate code for
the anemia (such as code D63.0, Anemia in
neoplastic disease).

Chapter 2: N

ICD-9-CM-Guideline

Anemia associated with chemotherapy,
immunotherapy and radiation therapy

When the admission/encounter is for management of
an anemia associated with chemotherapy,
immunotherapy or radiotherapy and the only
treatment is for the anemia, the anemia is sequenced
first. The appropriate neoplasm code should be
assigned as an additional code.

Neoplasms

ICD-10-CM - Guideline

c. 2. Anemia associated with chemotherapy,
immunotherapy and radiation therapy

When the admission/encounter is for management of
an anemia associated with an adverse effect of the
administration of chemotherapy or immunotherapy
and the only treatment is for the anemia, the anemia
code is sequenced first followed by the appropriate
codes for the neoplasm and the adverse effect
(T45.1X5, Adverse effect of antineoplastic and
immunosuppressive drugs).

When the admission/encounter is for management of
an anemia associated with an adverse effect of
radiotherapy, the anemia code should be sequenced
first, followed by the appropriate neoplasm code and
code Y84.2, Radiological procedure and radiotherapy
as the cause of abnormal reaction of the patient, or of
later complication, without mention of misadventure
at the time of the procedure.

Chapter 2: N

ICD-9-CM-Guideline

Management of dehydration due to the
malignancy

When the admission/encounter is for
management of dehydration due to the
malignancy or the therapy, or a
combination of both, and only the
dehydration is being treated (intravenous
rehydration), the dehydration is
sequenced first, followed by the code(s)
for the malignancy.

Neoplasms

ICD-10-CM - Guideline

c. 3. Management of dehydration due to the
malignancy

When the admission/encounter is for
management of dehydration due to the
malignancy and only the dehydration is
being treated (intravenous rehydration),
the dehydration is sequenced first,
followed by the code(s) for the
malignancy.

Chapter 2: N

ICD-9-CM-Guideline i. Malignancy

Malignancy in two or more A patient may
noncontiguous sites same organ.
or metastatic
None documentatio
to the status o
assigned.

Neoplasms

ICD-10-CM - Guideline

y in two or more noncontiguous sites

y have more than one malignant tumor in the
These tumors may represent different primaries
c disease, depending on the site. Should the
on be unclear, the provider should be queried as
of each tumor so that the correct codes can be

Chapter 2: N

ICD-9-CM-Guideline j. Disse

Disseminated malignant neoplasm, Code C
unspecified unspec
patient
None primar
be use
site an

Neoplasms

ICD-10-CM - Guideline

eminated malignant neoplasm, unspecified

C80.0, Disseminated malignant neoplasm,
cified, is for use only in those cases where the
t has advanced metastatic disease and no known
ry or secondary sites are specified. It should not
ed in the place of assigning codes for the primary
nd all known secondary sites.

Chapter 2: N

ICD-9-CM-Guideline k. Malign

Malignant neoplasm without Code C80
specification of site equates to
used whe
None primary s
be used in

Neoplasms

ICD-10-CM - Guideline

nant neoplasm without specification of site

0.1, Malignant (primary) neoplasm, unspecified,
to Cancer, unspecified. This code should only be
en no determination can be made as to the
site of the malignancy. This code should be rarely
n the inpatient setting.

Chapter 2: N

Sequencing of n

ICD-9-CM-Guideline l. Sequencing

None 1) Encounter

If the reason
malignancy, a
diagnosis. Th
by any metas

2) Encounter

When an enc
metastasis an
(secondary) s
the principal/
coded as an a

Neoplasms

neoplasm codes

ICD-10-CM - Guideline

g of neoplasm codes

r for treatment of primary malignancy

for the encounter is for treatment of a primary
assign the malignancy as the principal/first-listed
he primary site is to be sequenced first, followed
static sites.

r for treatment of secondary malignancy

counter is for primary malignancy with
nd treated is directed toward the metastatic
site(s) only, the metastatic site(s) is designated as
/first-listed diagnosis. The primary malignancy is
additional code.

Chapter 2: N

Sequencing of n

ICD-9-CM-Guideline

l. Seque

None 3) Malig

When a
code fro
complica
should b
code fro

Neoplasms

neoplasm codes

ICD-10-CM - Guideline

encing of neoplasm codes

gnant neoplasm in a pregnant patient

pregnant woman has a malignant neoplasm, a
om subcategory O9A.1-, Malignant neoplasm
ating pregnancy, childbirth, and the puerperium,
be sequenced first, followed by the appropriate
om Chapter 2 to indicate the type of neoplasm.

Chapter 2: N

Sequencing of n

ICD-9-CM-Guideline Sequencin
4) Encoun
Sequencing of neoplasm codes neoplasm
Encounter for complications
associated with a neoplasm

None When an en
associated w
treatment i
first, follow

The excepti
admission/e
with the ma
appropriate
or first-liste
neoplastic d

Neoplasms

neoplasm codes

ICD-10-CM - Guideline

ng of neoplasm codes
nter for complications associated with a
m

ncounter is for management of a complication
with a neoplasm, such as dehydration, and the
is only for the complication, the complication is coded
wed by the appropriate code(s) for the neoplasm.

ion to this guideline is anemia. When the
encounter is for management of an anemia associated
alignancy, and the treatment is only for anemia, the
e code for the malignancy is sequenced as the principal
ed diagnosis followed by code D63.0, Anemia in
disease.

Chapter 2: N
Sequencing of n

ICD-9-CM-Guideline S
5
Sequencing of neoplasm codes t
Complication from surgical procedure for
treatment of neoplasm

None W
c
p
d
li
c
h
s

Neoplasms
neoplasm codes

ICD-10-CM - Guideline

Sequencing of neoplasm codes
5) Complication from surgical procedure for
treatment of neoplasm

When an encounter is for treatment of a
complication resulting from a surgical procedure
performed for the treatment of the neoplasm,
designate the complication as the principal/first-
isted diagnosis. See guideline regarding the
coding of a current malignancy versus personal
history to determine if the code for the neoplasm
should also be assigned.

Chapter 2: N
Sequencing of n

ICD-9-CM-Guideline S
6
Sequencing of neoplasm codes
Pathologic fracture due to neoplasm

None W
d
t
P
s
fo

If
a
c
c

Neoplasms
neoplasm codes

ICD-10-CM - Guideline

Sequencing of neoplasm codes
6) Pathologic fracture due to neoplasm

When an encounter is for a pathological fracture
due to a neoplasm, and the focus of treatment is
the fracture, a code from subcategory M84.5,
Pathological fracture in neoplastic disease,
should be sequenced first, followed by the code
or the neoplasm.

f the focus of treatment is the neoplasm with an
associated pathological fracture, the neoplasm
code should be sequenced first, followed by a
code from M84.5 for the pathological fracture.

Chapter 2: N
Sequencing of n

ICD-9-CM-Guideline

Sequencing of ne
m. Current malig

None When a primary m
treatment, such as
radiation therapy
primary malignanc
completed.
When a primary m
eradicated from it
malignancy) direct
existing primary m
history of maligna
former site of the

Neoplasms
neoplasm codes

ICD-10-CM - Guideline

eoplasm codes
gnancy versus personal history of malignancy

malignancy has been excised but further
s an additional surgery for the malignancy,
or chemotherapy is directed to that site, the
cy code should be used until treatment is

malignancy has been previously excised or
ts site, there is no further treatment (of the
ted to that site, and there is no evidence of any
malignancy, a code from category Z85, Personal
ant neoplasm, should be used to indicate the
malignancy.

Chapter 2: N
Sequencing of n

ICD-9-CM-Guideline Sequen
n. Leuke
Sequencing of neoplasm codes Plasma
Leukemia, Multiple Myeloma, and history
Malignant Plasma Cell Neoplasms in
remission versus personal history

None The cat
myelom
codes in
achieve
Persona
history
hemato
If the do
leukem
be quer

Neoplasms
neoplasm codes

ICD-10-CM - Guideline

ncing of neoplasm codes
kemia, Multiple Myeloma, and Malignant
a Cell Neoplasms in remission versus personal

tegories for leukemia, and category C90, Multiple
ma and malignant plasma cell neoplasms, have
ndicating whether or not the leukemia has
ed remission. There are also codes Z85.6,
al history of leukemia, and Z85.79, Personal

of other malignant neoplasms of lymphoid,
opoietic and related tissues.
ocumentation is unclear, as to whether the
mia has achieved remission, the provider should
ried.

Chapter 2: N
Sequencing of n

ICD-9-CM-Guideline S
o
None p
m
q
m

S
w

Neoplasms
neoplasm codes

ICD-10-CM - Guideline

Sequencing of neoplasm codes
o. Aftercare following surgery for neoplasm
p. Follow-up care for completed treatment of
malignancy
q. Prophylactic organ removal for prevention of
malignancy

See Section I.C.21 Factors influencing health status and contact
with health services