ICD-10-CM Chapter 2: Neoplasms (C00-D49)
Important terminology
Neoplasm refers to any new growth. An abnormal mass of tissue that forms when cells grow and divide more than they
should or do not die when they should. Neoplasms may be benign (not cancer) or malignant (cancer).
The difference between a tumor and a neoplasm is that a tumor refers to swelling or a lump like swollen state
that would normally be associated with inflammation, whereas a neoplasm refers to any new growth, lesion, or
ulcer that is abnormal
Primary Neoplasm is defined as the original site (organ or tissue) where cancer began. The place where a cancer starts is
called the primary site. The cancer that starts there is the primary tumor. For example, if the cancer starts in the breast,
the patient have primary breast cancer.
Secondary Neoplasm: A term used to describe cancer that has spread (metastasized) from the place where it first started
to another part of the body.
Cancer starts to grow in this new place. The place where it now grows is called the secondary site. The cancer is called a
secondary tumor or metastasis. If your breast cancer spreads to the lungs, for example, you have secondary breast
cancer. Your secondary cancer is made from breast cancer cells, not lung cancer cells. Therefore, the patient still have
breast cancer, even though it is now in your lungs.
What is Metastasis? Metastasis means that cancer spreads to a different body part from where it started. When this
happens, doctors say the cancer has “metastasized.” Metastases most commonly develop when cancer cells break away
from the main tumor and enter the bloodstream or lymphatic system.
Benign Neoplasm: Benign tumors are noncancerous growths in the body. Unlike cancerous tumors, they do not spread
(metastasize) to other parts of the body.
For example, adenoma, Lipoma, Myomas , Nevi, Fibroma or fibroids
Malignant Neoplasm: Malignant means that the tumor is made of cancer cells, and it can invade nearby tissues. Some
cancer cells can move into the bloodstream or lymph nodes, where they can spread to other tissues within the body—this
is called metastasis.
For example, breast cancer begins in the breast tissue and may spread to lymph nodes in the armpit if it has not
caught early enough and treated. Once breast cancer has spread to the lymph nodes, the cancer cells can travel
to other areas of the body, like the liver or bones.
In situ Neoplasm- mean 'on site', 'in place' or 'in position'. A group of abnormal cells that remain in the place where they
first formed .These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
Uncertain histologic behavior- behavior of a tumor cannot be predicted through pathology. This means your doctor needs more
information to determine whether your neoplasm is malignant or benign.
Malignant Neoplasm Overlapping Site Boundaries: A single neoplasm that overlaps two or more contiguous sites within a three-
character category and whose point of origin cannot be determined should be coded to the subcategory . 8,
"overlapping lesion," unless the combination is specifically indexed elsewhere.
DIFFERENCE BETWEEN BENIGN AND MALIGNANT NEOPLASM
TREATMENT
COMPLICATION
Chemotherapy can cause
1. fatigue,
2. loss of appetite,
3. nausea,
4. bowel issues such as constipation or diarrhoea,
5. hair loss,
6. mouth sores,
7. skin and nail problems.
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 of origin mentioned, e.g., ectopic
pancreatic malignant neoplasms involving the stomach are coded to malignant neoplasm of pancreas,
unspecified (C25.9).
The neoplasm table in the Alphabetic Index should be referenced first. However, if the histological term
is documented, that term should be referenced first, rather than going immediately to the Neoplasm
Table, in order to determine which column in the Neoplasm Table is appropriate. For example, if the
documentation indicates “adenoma,” refer to the term in the Alphabetic Index to review the entries
under this term and the instructional note to “see also neoplasm, by site, benign.” The table provides the
proper code based on the type of neoplasm and the site. It is important to select the proper column in
the table that corresponds to the type of neoplasm. The Tabular List should then be referenced to verify
that the correct code has been selected from the table and that a more specific site code does notexist.
a. Treatment directed at the malignancy
If the treatment is directed at the malignancy, designate the malignancy as the principal diagnosis.
The only exception to this guideline is if a patient admission/encounter is solely for the
administration of chemotherapy, immunotherapy or external beam radiation therapy, assignthe
appropriate Z51.-- code as the first-listed or principal diagnosis, and the diagnosis or problem for
which the service is being performed as a secondary diagnosis.
b. Treatment of secondary site
When a patient is admitted because of a primary neoplasm with metastasis and treatment is
directed toward the secondary site only, the secondary neoplasm is designated as the principal
diagnosis even though the primary malignancy is still present.
c. Coding and sequencing of complications
Coding and sequencing of complications associated with the malignancies or with the therapythereof are
subject to the following guidelines:
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 malignancyis 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).
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 onlytreatment 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 anemiacode 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.
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
4) Treatment of a complication resulting from a surgical procedure
When the admission/encounter is for treatment of a complication resulting from a surgical
procedure, designate the complication as the principal or first-listed diagnosis iftreatment is
directed at resolving the complication.
d) Primary malignancy previously excised
When a primary malignancy has been previously excised or eradicated from its site and there is no
further treatment directed to that site and there is no evidence of any existing primary malignancy
at that site, a code from category Z85, Personal history of malignant neoplasm, should be used to
indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to
another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the
principal or first-listed diagnosis with the Z85 code used as a secondary code
e. Admissions/Encounters involving chemotherapy, immunotherapy and radiation
therapy
1) Episode of care involves surgical removal of neoplasm
When an episode of care involves the surgical removal of a neoplasm, primary or secondarysite,
followed by adjunct chemotherapy or radiation treatment during the same episode of care, the code
for the neoplasm should be assigned as principal or first-listed diagnosis.
f. Patient admission/encounter solely for administration of chemotherapy,
immunotherapy and radiation therapy
If a patient admission/encounter is solely for the administration of chemotherapy,
immunotherapy or external beam radiation therapy assign code Z51.0, Encounter for
antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or
Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a
patient receives more than one of these therapies during the same admission more than one of
these codes may be assigned, in any sequence
The malignancy for which the therapy is being administered should be assigned as a secondary
diagnosis.
If a patient admission/encounter is for the insertion or implantation of radioactive elements
(e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the
principal or first-listed diagnosis. Code Z51.0 should not be assigned.
1) Patient admitted for radiation therapy, chemotherapy or immunotherapy and
develops complications
When a patient is admitted for the purpose of external beam radiotherapy, immunotherapy
or chemotherapy and develops complications such as uncontrolled nausea and vomiting or
dehydration, the principal or first-listed diagnosis is Z51.0, Encounter for antineoplastic
radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12,
Encounter for antineoplastic immunotherapy followed by any codes for the complications.
When a patient is admitted for the purpose of insertion or implantation of radioactive
elements (e.g., brachytherapy) and develops complications such as uncontrolled nausea and
vomiting or dehydration, the principal or first-listed diagnosis is the appropriate code for the
malignancy followed by any codes for the complications
g. Admission/encounter to determine extent of malignancy
When the reason for admission/encounter is to determine the extent of the malignancy, or for a
procedure such as paracentesis or thoracentesis, the primary malignancy or appropriate
metastatic site is designated as the principal or first-listed diagnosis, even though chemotherapy
or radiotherapy is administered.
h. Symptoms, signs, and abnormal findings listed in Chapter 18 associated
with neoplasms
Symptoms, signs, and ill-defined conditions listed in Chapter 18 characteristic of, or associated
with, an existing primary or secondary site malignancy cannot be used to replace the malignancy
as principal or first-listed diagnosis, regardless of the number of admissions or encounters for
treatment and care of the neoplasm. See section I.C.21. Factors influencing health status and
contact with health services, Encounter for prophylactic organ removal.
i. Admission/encounter for pain control/management
See Section I.C.6. for information on coding admission/encounter for pain control/management.
j. Malignancy in two or more noncontiguous sites
A patient may have more than one malignant tumor in the same organ. 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.
k. 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 site.
l. Malignant neoplasm without specification of site
Code C80.1, Malignant (primary) neoplasm, unspecified, equates to Cancer, unspecified.
This code should only be used when no determination can be made as to the primary site
of a malignancy. This code should rarely be used in the inpatient setting.
m. Sequencing of neoplasm codes
1) Encounter for treatment of primary malignancy
If the reason for the encounter is for treatment of a primary malignancy, assign the
malignancy as the principal/first-listed diagnosis. The primary site is to be sequenced
first, followed by any metastatic sites.
2) Encounter for treatment of secondary malignancy
When an encounter is for a primary malignancy with metastasis and treatment is
directed toward the metastatic (secondary) site(s) only, the metastatic site(s) is
designated as the principal/first-listed diagnosis. The primary malignancy is coded
as an additional code.
3) Malignant neoplasm in a pregnant patient
When a pregnant woman has a malignant neoplasm, a code from subcategory O9A.1-
, Malignant neoplasm complicating pregnancy, childbirth, and the puerperium,
should be sequenced first, followed by the appropriate code from
Chapter 2 to indicate the type of neoplasm.
4) Encounter for complication associated with a neoplasm
When an encounter is for management of a complication associated with a neoplasm,
such as dehydration, and the treatment is only for the complication, the complication
is coded first, followed by the appropriate code(s) for the neoplasm
The exception to this guideline is anemia. When the 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 code D63.0, Anemia in neoplastic disease.
5) Complication from surgical procedure for treatment of a 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-listed diagnosis. See the guideline regarding the coding of a current
malignancy versus personal history to determine if the code for the neoplasm should
also be assigned.
6) Pathologic fracture due to a 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 for the neoplasm.
If 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.
n. Current malignancy versus personal history of malignancy
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. When a primary malignancy has been previously excised or eradicated
from its site, there is no further treatment(of the malignancy) directed to that site,
and there is no evidence of any existing primary malignancy at that site, a code from
category Z85, Personal history of malignant neoplasm, should be used to indicate
the former site of the malignancy. Codes from subcategories Z85.0 – Z85.85 should
only be assigned for the former site of a primary malignancy, not the site of a
secondary malignancy. Code Z85.89 may be assigned for the former site(s) of either
a primary or secondary malignancy.
o. Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission
versus personal history
The categories for leukemia, and category C90, Multiple myeloma and malignant
plasma cell neoplasms, have codes indicating whether or not the leukemia has
achieved remission. There are also codes Z85.6, Personal history of leukemia, and
Z85.79, Personal history of other malignant neoplasms of lymphoid,
hematopoietic and related tissues. If the documentation is unclear as to whether
the leukemia has achieved remission, the provider should be queried.
r. Malignant neoplasm associated with transplanted organ
A malignant neoplasm of a transplanted organ should be coded as a transplant
complication. Assign first the appropriate code from category T86.-, Complications of
transplanted organs and tissue, followed by code C80.2, Malignant neoplasm
associated with transplanted organ. Use anadditional code for the specific
malignancy.
CODING SCENARIOS
QUESTIONS AND ANSWERS
1. This 76-year-old man, originally diagnosed with left upper lobe carcinoma 5
years ago, is seen for a fracture of the shaft of the right femur. Eight months
ago, he was diagnosed with metastatic bone cancer (from the lung) and this
fracture is a result of the metastatic disease. Thispatient’s lung cancer was
treated with radiation and there is no longer evidence of an existing primary
malignancy. What diagnosis codes are assigned for this case?
2. This 45-year-old female is currently being treated for chronic kidney disease, stage
three. She has previously undergone a kidney transplant but still continues to
suffer from chronic kidney disease. This patient is also treated for hypothyroidism
following removal of the thyroid for thyroid carcinoma. At this time, there is no
longer evidence of an existing thyroid malignancy. What diagnosis codes are
assigned?
3. This nursing home patient has extensive cellulitis of the abdominal wall. The
examination performed reveals that his existing gastrostomy site is infected. He
hada feeding tube inserted four months ago because ofcarcinoma of the middle
esophagus. The physician confirmed that the responsible organism for the infection
is methicillin resistant Staph.
Aureus (MRSA). What diagnosis codes are assigned?
4. Patient with viral hepatitis C and continued alcohol use is diagnoses with
malignant primary neoplasm of the liver.
a. C22.8
b. C22.9
c. C22.8, B19.20, F10.99
d. C22.9, B17.10
5. Following a previous surgery the patient suffered blood loss that required a
packed red cell transfusion He continues to be anemic as evidenced by a low
blood count. What is the correct ICD-10-CM code forthe acute anemia due to
hemorrhaging?
A. D62
B. D50.0
C. D50.8
D. D50.9
6. Dr. C sees a patient with nasal hemorrhage and performs a fiber-optic exam
of the nasopharynx. A mass is encountered at the nasal concha anda biopsy is
taken. Pathology report shows cancer. Additional surgery is planned .
a. C31.1
b. C32.3
c. C30.0
d. C10.2
7. Patient arrived in the ED complaining of having severe right upper quadrant
pain, nausea and vomiting for several weeks with 20 lb weight loss. Tests
revealed a mass within the gallbladder. However, no cholecystitis or stones. The
patient was admitted and a surgeon was consulted. The next day a
cholecystectomy was performed. The pathologyresults show the patient to have
cancer of the gallbladder. Code the diagnosis for the surgery.
a. R10.80
b. C23
c. C24.0
d. R10.0. R11.2. R63.4
8.73-year-old white female with a large rapidly growing malignant tumor in the
left breast extending from the upper outer quadrant into the axillary tail
9.A 52-year old white female with two distinct lesions of the right breast, one
(0.5 cm) in the upper outer quadrant and a second (1.5 cm) in the lower outer
quadrant; path report indicates both lesions are malignant.
10. Patient with primary prostate cancer with metastasis to lungs
admitted for wedge resection of mass in right lung
11. Patient is admitted for treatment of anemia in advanced colon cancer
12. A 56-year-old Hispanic male with grade II follicular lymphoma involving multiple
lymph node sites referred for blood transfusion to treat anemia due to
chemotherapy
13. Patient has primary colon cancer with metastasis to rib and is evaluated for
possible excision of portion of rib bone
14. Patient with pancreatic cancer is seen for initiation of TPN forcancer-
related moderate protein-calorie malnutrition
15. A 30-year-old pregnant female in second trimester evaluated forthyroid
malignancy
16. Malignant neoplasm of the axillary tail of the left male breast
17. Hairy cell leukemia
18. When a patient with a current neoplasm is referred to home health for treatment of
an anemia caused by chemotherapy or immunotherapy only, which of the following is the
correct sequencing ofcodes?
a. Anemia, malignancy and adverse effect of the chemotherapy or immunotherapy.
b. Malignancy, anemia, adverse effect of the chemotherapy or immunotherapy.
c. Adverse effect of the chemotherapy or immunotherapy, the malignance, anemia
d. Malignancy, adverse effect of the chemotherapy or immunotherapy and the anemia
19. The patient is a 46-year-old heavy drinker with cancer of the colon and rectum at the
rectosigmoid junction.
20. Ovarian carcinoma with malignant ascites and metastasis to the peritoneal cavity,
admitted for thedrainage of ascites:
21. Aleukemic myeloid leukemia, in remission:
Exercises
2. Malignant neoplasm of the axillary tail of the left male breast
C50.622
3. Hairy cell leukemia
C91.40
4. When a patient with a current neoplasm is referred to home health for treatment of an
anemia caused by chemotherapy or immunotherapy only, which of the following is the
correct sequencing of codes?
a. Anemia, malignancy and adverse effect of the chemotherapy or immunotherapy.
b. Malignancy, anemia, adverse effect of the chemotherapy or immunotherapy.
c. Adverse effect of the chemotherapy or immunotherapy, the malignance, anemia
d. Malignancy, adverse effect of the chemotherapy or immunotherapy and the anemia
5. The patient is a 46-year-old heavy drinker with cancer of the colon and rectum at the
rectosigmoid junction.
C19
6. Ovarian carcinoma with malignant ascites and metastasis to the peritoneal cavity,
admitted for the drainage of ascites:
R18.0, C56.9, and C78.6
7. Aleukemic myeloid leukemia, in remission:
C92.Z1
8. IntrapelvicHodgkin'granulm
aa:C81.96
9. Diffuse large B-cell lymphoma intra-abdominal:
C83.33