1 Sept 2016

Chapter 2: Neoplasm’s (C00-D49)

Neoplasm: A new and abnormal growth of tissue in a part of the body.


Types of neoplasm

       1.      Benign  (Non-cancerous)

             2.      Malignant  (Primary and Secondary)

             3.      Ca in situ  (Cancerous)

             4.      Uncertain behavior (Benign nature to Malignancy)

             5.      Unspecified  


The neoplasm table in the Alphabetic Index should be referenced first.


However, if the histological term is documented, that term should be referenced first index of disease, then search in the Neoplasm Table.


                      Eg: Adenoma, Sarcoma, Fibroma, Androblastoma etc..


It is very important to select the proper column in the neoplasm table to the respective type of neoplasm.




          1.      Based on the encounter, assign it to the primary and secondary diagnosis.


                    A.    If the patient is having both primary and secondary neoplasm and treatment is for the primary site, then assign primary site as the first diagnosis followed by metastatic.


                    B.      If the patient is having both primary and secondary neoplasm and treatment is for the secondary site, and then assign secondary neoplasm as the first diagnosis followed by the primary neoplasm.


          2.      When a primary malignancy has been excised but further treatment, such as an additional surgery for the malignancy, radiation therapy or chemotherapy is directed to that site, the primary malignancy code should be used until treatment is completed.


          3.      If the primary malignancy has been previously excised from its site and there is no further treatment required to that site, a code from category Z85 (Personal history of malignant neoplasm) should be used.


Any metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal diagnosis with Z85.


         4.      Anemia associated with malignancy and the treatment is only for anemia, The malignancy is sequenced first followed by anemia code (D63.0)


         5.      Dehydration due to the malignancy and only the treatment is for dehydration, the dehydration is sequenced first followed by malignancy code.


         6.      Pathological fracture due to a neoplasm,


           A.  If an encounter is for pathological fracture, a code from subcategory M84.5 (pathological fracture due to neoplasm) should be sequenced first, followed by the code for the neoplasm.

          B.  If an encounter is for neoplasm, it should be sequenced first followed by M84.5


         7.   Surgical removal of neoplasm followed by chemo/radiation therapy during the same episode of care, Neoplasm should be sequenced first.


         8.      If the encounter is for chemo/immune/radiation therapy, use ‘Z’ primary code.


             Z51.0 (Encounter for antineoplastic radiation therapy)

             Z51.11 (Encounter for antineoplastic chemotherapy)

             Z51.12 (Encounter for antineoplastic immunotherapy)           


            The malignancy for which therapy is given should be used as a second code.


            If any complication develops, it would be assigned as the secondary code. 


         9.   C80.1 (Malignant neoplasm) Unspecified. 


        10.  C80.0 (Disseminated malignant neoplasm).


         11.  Malignant neoplasm in pregnancy patient, Use O9A.1 – (Malignant neoplasm complicating pregnancy, childbirth, and the puerperium) as primary Dx followed by a code for malignancy.



Test your Knowledge: 

        A. Chapter 2 Quiz