Chapter II - Neoplasms Flashcards
Understand the standards of Chapter II
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?
any accompanying complications or secondary conditions
DChS.II.2: Anemia in neoplastic disease
When anemia is due to a neoplasm what type of codes must be used?
Dagger and Asterisk
Neoplasm = Dagger
Anemia = Asterisk
(sequencing depends on main condition treated)
DChS.II.2: Anemia in neoplastic disease
For what type of neoplastic diseases must anemia not be coded?
Neoplastic blood disorders leukaemia, myeloma and myelodysplasia. (because it is a natural symptom of these diseases)
DChS.II.2: Anemia in neoplastic disease
When can the code D36.0A Anemia in neoplastic disease be assigned?
Only when the responsible consultant has specified that the anemia is DUE TO the neoplasm (a link must be made)
Name the five columns found in the Neoplasm Table.
- Malignant Primary
- Malignant Secondary
- In situ
- Benign
- Uncertain or unknown behaviour
What are the two special symbols found in the Neoplasm Table?
and diamond
When indexing neoplasm codes, what must be indexed first?
The histological type (if known), to be directed to the appropriate column in the Neoplasm Table.
DCS.II.1: Primary and secondary malignant neoplasms
Name any predominantly secondary sites.
- bone
- brain and spinal cord (including meninges)
- lymph nodes
- pleura
- peritoneum and retroperitoneum
- heart
- mediastinum and diaphragm
- liver
DCS.II.1: Primary and secondary malignant neoplasms
All malignancies are coded as primary (except those listed as predominantly secondary), unless:
- 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
DCS.II.1: Primary and secondary malignant neoplasms
When can C80.0 Malignant neoplasm, primary site unknown, so stated be assigned?
Only when the responsible consultant has explicitly documented within the medical record that the primary site is unknown.
DCS.II.1: Primary and secondary malignant neoplasms
Where a secondary malignancy is documented, what must also be coded?
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.
DCS.II.1: Primary and secondary malignant neoplasms
When can a personal history of malignant neoplasm code be assigned? (Z85.-)
When a malignant neoplasm is no longer present and the primary treatment has been completed.
DCS.II.1: Primary and secondary malignant neoplasms
Explain how malignant neoplasms should be sequenced when a primary and secondary malignant neoplasm are documented.
The primary malignant neoplasm should be sequenced first, unless the secondary malignant neoplasm is the main condition treated/investigated.
DCS.II.2: Metastatic cancer
How should a cancer described as ‘metastatic from’ a site be interpreted?
As primary from the stated site
e.g. metastatic neoplasm from breast (breast is primary)
DCS.II.2: Metastatic cancer
How should a cancer described as ‘metastatic to’ a site be interpreted?
As a secondary of the stated site
e.g. metastatic neoplasm to lung (lung is secondary)
DCS.II.4: Multiple independent primary malignant neoplasms
When must C97.X be assigned in primary position?
When 2 or more independant primary malignant neoplasms have been recorded but none clearly predominate.
DCS.II.4: Multiple independent primary malignant neoplasms
When must C97.X not be assigned?
When multiple primary neoplasms exist and it is clear which neoplasm predominates.
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?
As a primary malignant neoplasm of the same site
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?
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.
DCS.II.7: Secondary neoplasms or metastases from haematological malignan
Which codes must never be assigned with codes C81-C96 haematological malignancies?
Codes from C77-C79 to indicate a secondary neoplasm due/to from a haematological malignancy.
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?
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.
DCS.II.9: In situ neoplasms with microinvasion
How must a carcinoma in situ with evidence of microinvasion be coded?
As a malignant neoplasm
DCS.II.12: Neoplasms of uncertain or unknown behaviour
When can codes from D37-D48 Neoplasms of uncertain or unknown behaviour be assigned?
Only when…
* directed to via the Alphabetical index
OR
* it is documented in the medical record as of uncertain or unknown behaviour
