These tumors may represent different primaries or metastatic disease depending

These tumors may represent different primaries or

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These tumors may represent different primaries or metastatic disease, depending on the site. Should the documentation be unclear, the provider should be queried as to the status of each tumor so that the correct codes can be assigned. j. Disseminated malignant neoplasm, unspecified Code C80.0, Disseminated malignant neoplasm, unspecified, is for use only in those cases where the patient has advanced metastatic disease and no known primary or secondary sites are specified. It should not be used in place of assigning codes for the primary site and all known secondary sites. A 55-year-old male with a large malignant rectal tumor has been receiving external radiation therapy to shrink the tumor prior to planned surgery. He is admitted today for a blood transfusion to treat anemia related to radiation therapy. D64.89 Other specified anemias C20 Malignant neoplasm of rectum 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 Explanation : The code for the anemia is sequenced first, followed by the code for the malignancy, and lastly the code for the abnormal reaction due to radiotherapy. History of breast cancer, left radical mastectomy 18 months ago with no current treatment; bronchoscopy with lung biopsy shows metastatic disease in the right lung C78.01 Secondary malignant neoplasm of right lung Z85.3 Personal history of malignant neoplasm of breast Explanation : The patient has undergone a diagnostic procedure that revealed metastatic breast cancer in the right lung. The code for the secondary (metastatic) site is sequenced first followed by a personal history code to identify the former site of the primary malignancy. Patient is admitted for second round of rituximab and fludarabine for his chronic B cell lymphocytic leukemia Z51.11 Encounter for antineoplastic chemotherapy Z51.12 Encounter for antineoplastic immunotherapy C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission Explanation : Rituximab is an antineoplastic immunotherapy while fludarabine is an antineoplastic chemotherapy. The two treatments are often used together. The admission was solely for the purpose of administering this treatment and either can be sequenced first, before the neoplastic condition. Patient with left lung cancer with malignant pleural effusion admitted for paracentesis and initiation/administration of chemotherapy C34.92 Malignant neoplasm of unspecified part of left bronchus or lung J91.0 Malignant pleural effusion Z51.11 Encounter for antineoplastic chemotherapy Explanation : The lung cancer is sequenced before the chemotherapy in this instance because the paracentesis for the malignant effusion is also being performed. An instructional note under the malignant effusion instructs that the lung cancer be sequenced first.
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