Chapter II - Neoplasms

Question 1

DChS.II.1: Complications and symptoms of neoplasms

When it has been determined that a neoplasm is present, the neoplasm and ….what else must be coded?

Answer 1

any accompanying complications or secondary conditions

Question 2

DChS.II.2: Anemia in neoplastic disease

When anemia is due to a neoplasm what type of codes must be used?

Answer 2

Dagger and Asterisk
Neoplasm = Dagger
Anemia = Asterisk
(sequencing depends on main condition treated)

Question 3

DChS.II.2: Anemia in neoplastic disease

For what type of neoplastic diseases must anemia not be coded?

Answer 3

Neoplastic blood disorders leukaemia, myeloma and myelodysplasia. (because it is a natural symptom of these diseases)

Question 4

DChS.II.2: Anemia in neoplastic disease

When can the code D36.0A Anemia in neoplastic disease be assigned?

Answer 4

Only when the responsible consultant has specified that the anemia is DUE TO the neoplasm (a link must be made)

Question 5

Name the five columns found in the Neoplasm Table.

Answer 5

1. Malignant Primary
2. Malignant Secondary
3. In situ
4. Benign
5. Uncertain or unknown behaviour

Question 6

What are the two special symbols found in the Neoplasm Table?

Answer 6

and diamond

Question 7

When indexing neoplasm codes, what must be indexed first?

Answer 7

The histological type (if known), to be directed to the appropriate column in the Neoplasm Table.

Question 8

DCS.II.1: Primary and secondary malignant neoplasms

Name any predominantly secondary sites.

Answer 8

• bone
• brain and spinal cord (including meninges)
• lymph nodes
• pleura
• peritoneum and retroperitoneum
• heart
• mediastinum and diaphragm
• liver

Question 9

DCS.II.1: Primary and secondary malignant neoplasms

All malignancies are coded as primary (except those listed as predominantly secondary), unless:

Answer 9

• they are specified as secondary (or metastatic)
  OR
• the site stated is marked with a diamond and is a carcinoma or adenocarcinoma of any type other than intraosseous or odontogenic

Question 10

DCS.II.1: Primary and secondary malignant neoplasms

When can C80.0 Malignant neoplasm, primary site unknown, so stated be assigned?

Answer 10

Only when the responsible consultant has explicitly documented within the medical record that the primary site is unknown.

Question 11

DCS.II.1: Primary and secondary malignant neoplasms

Where a secondary malignancy is documented, what must also be coded?

Answer 11

A primary malignancy, even if the site is unspecified or stated as unknown.
Exception: if the primary malignancy is documented as no longer present, in which case a code from Z85.- must be assigned.

Question 12

DCS.II.1: Primary and secondary malignant neoplasms

When can a personal history of malignant neoplasm code be assigned? (Z85.-)

Answer 12

When a malignant neoplasm is no longer present and the primary treatment has been completed.

Question 13

DCS.II.1: Primary and secondary malignant neoplasms

Explain how malignant neoplasms should be sequenced when a primary and secondary malignant neoplasm are documented.

Answer 13

The primary malignant neoplasm should be sequenced first, unless the secondary malignant neoplasm is the main condition treated/investigated.

Question 14

DCS.II.2: Metastatic cancer

How should a cancer described as ‘metastatic from’ a site be interpreted?

Answer 14

As primary from the stated site

e.g. metastatic neoplasm from breast (breast is primary)

Question 15

DCS.II.2: Metastatic cancer

How should a cancer described as ‘metastatic to’ a site be interpreted?

Answer 15

As a secondary of the stated site

e.g. metastatic neoplasm to lung (lung is secondary)

Question 16

DCS.II.4: Multiple independent primary malignant neoplasms

When must C97.X be assigned in primary position?

Answer 16

When 2 or more independant primary malignant neoplasms have been recorded but none clearly predominate.

Question 17

DCS.II.4: Multiple independent primary malignant neoplasms

When must C97.X not be assigned?

Answer 17

When multiple primary neoplasms exist and it is clear which neoplasm predominates.

Question 18

DCS.II.5: Recurrent primary malignant neoplasms

How should new primary neoplasms in the same site as a previously excised/eradicated primary malignant neoplsm be coded?

Answer 18

As a primary malignant neoplasm of the same site

Question 19

DCS.II.6: Further/wider excision of malignant and in-situ neoplasms

If a further/wider excision of a previously removed primary, secondary or in-situ neoplasm is carried out, and the histology is reported as negative, how should this be coded?

Answer 19

It must continue to be coded as the neoplasm that was originally treated as it would still be considered part of the primary treatment for the original neoplasm.

Question 20

DCS.II.7: Secondary neoplasms or metastases from haematological malignan

Which codes must never be assigned with codes C81-C96 haematological malignancies?

Answer 20

Codes from C77-C79 to indicate a secondary neoplasm due/to from a haematological malignancy.

Question 21

When should the personal history codes Z85.6 Personal history of leukaemia or Z85.7 Personal history of other malignant neoplasms of lymphoid, haematopoietic and related tissues be assigned as the primary diagnosis?

Answer 21

When a patient with leukemia or other malignant neoplasm of lymphoid, haematopoietic and related tissues is in remission and receiving maintenance chemotherapy to keep their condition in remission.

Question 22

DCS.II.9: In situ neoplasms with microinvasion

How must a carcinoma in situ with evidence of microinvasion be coded?

Answer 22

As a malignant neoplasm

Question 23

DCS.II.12: Neoplasms of uncertain or unknown behaviour

When can codes from D37-D48 Neoplasms of uncertain or unknown behaviour be assigned?

Answer 23

Only when…
* directed to via the Alphabetical index
OR
* it is documented in the medical record as of uncertain or unknown behaviour