June 6, 2011
Coding for Liver Cancer
Liver cancer, also documented as primary liver cancer or hepatoma, is usually caused by cirrhosis or scarring of the liver, which may be due to alcohol abuse, autoimmune diseases of the liver, hepatitis B or C, or hemochromatosis.
Typically, cancer found in the liver has metastasized there from another part of the body. The cancer cells detach from the primary site, such as the breast or the lungs, and travel through the circulatory or lymphatic system to the liver. The liver is the second most common site for metastatic disease, with lymph nodes being the first.
Primary Liver Cancer
• Hepatocellular carcinoma (155.0), the most common form, starts in the hepatocytes.
• Cholangiocarcinoma (155.1) begins in small bile ducts in the liver. Cholangiocarcinoma combined with hepatocellular carcinoma is classified to code 155.0.
• Hepatoblastoma (155.0) may be caused by an abnormal gene. This type affects children younger than the age of 4.
• Angiosarcoma (155.0) or hemangiosarcoma (155.0) begins in the blood vessels of the liver.
Benign Liver Tumors
• Hemangioma (228.04) most commonly affects the liver’s blood vessels.
• Hepatic adenoma (211.5) originates in hepatocytes and may be caused by birth control pills.
• Focal nodular hyperplasia is a combination of several types of cells.
ICD-9-CM Code Assignment
Signs and Symptoms
If the liver biopsy is done by a laparoscope, assign code 50.14. If the physician performs a needle biopsy of the liver through a laparotomy, assign codes 54.11, Exploratory laparotomy, and 50.11, Closed liver biopsy (AHA Coding Clinic for ICD-9-CM, 1988, fourth quarter, page 12). The closed biopsy code will be assigned because the biopsy technique used to obtain the tissue sample involved a needle despite the procedure being done through an open approach. Open or wedge biopsy is classified to code 50.12. Transjugular or transvenous liver biopsy is assigned to code 50.13.
• Stage 1: a single tumor confined to the liver;
• Stage 2: a single tumor invading nearby blood vessels or multiple small tumors in the liver;
• Stage 3: several larger tumors in the liver or one large tumor invading the liver’s main veins or nearby structures, such as the gallbladder;
• Stage 4: cancer has spread to other parts of the body; or
• Recurrent: cancer has returned to the liver or another part of the body after treatment.
• Surgery: partial hepatectomy (50.22), which may also be documented as wedge resection of liver; lobectomy of liver (50.3), which is the complete removal of a lobe of the liver; or total hepatectomy (50.4), the complete removal of the liver.
• Radiation therapy.
• Alcohol injection (50.94): Pure alcohol is injected directly into tumors, which will dry out the cells in the tumor so the cells eventually die.
• Radio-frequency ablation: An electric current in the radio-frequency range is used to destroy malignant cells. Thin needles are inserted into the tumor and heated with an electric current. Open ablation of the liver is classified to code 50.23. Code 50.24 identifies percutaneous ablation of the liver. Code 50.25 is for laparoscopic ablation of the liver, and other and unspecified ablation of the liver goes to 50.26.
• Cryosurgery/cryotherapy (50.29): Extreme cold is used to destroy cancer cells. If this procedure is done laparoscopically, assign code 50.25.
• Liver transplantation (50.59): The diseased liver is removed and replaced with a healthy donated organ. This procedure is rarely used for patients with liver cancer because, in most cases, the cancer recurs outside the liver after the transplant.
Coding and sequencing for liver cancer are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.
— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.
Coding for Liver Cancer in ICD-10-CM
Several carcinoma types are specified in ICD-10-CM, which ICD-9-CM did not identify with separate codes. For malignant neoplasm of liver and intrahepatic bile duct, the following codes are available:
• C22.0, Liver cell carcinoma (including hepatocellular carcinoma and hepatoma);
• C22.1, Intrahepatic bile duct carcinoma (including cholangiocarcinoma);
• C22.2, Hepatoblastoma;
• C22.3, Angiosarcoma (including Kupffer cell sarcoma);
• C22.4, Other sarcomas of liver;
• C22.7, Other specified carcinomas of liver;
• C22.8, Malignant neoplasm of liver, primary, unspecified as to type; and
• C22.9, Malignant neoplasm of liver, not specified as primary or secondary.
— Audrey Howard