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For other articles and previous issues click here. August 15, 2005 Coding
for Lung Cancer Lung cancer is any type of malignant growth in the lungs, which occurs when cells in the lung start to grow rapidly in an uncontrolled manner. Tobacco smoke is the main cause of damage to the cells in the lungs. Lung cancer is the leading cause of cancer death. Types of Lung Cancer • Small cell lung cancer (SCLC) — also called oat cell cancer, spreads rapidly and is more likely than other types to have metastasized • Squamous cell carcinoma — also called epidermoid carcinoma • Adenocarcinoma — likely to spread to lymph nodes and other organs • Large cell carcinoma — cells that are not diagnosed as squamous, adenocarcinoma, or SCLC are categorized under this heading Regardless of the cell type, the AHA Coding Clinic for ICD-9-CM code for primary malignant neoplasm of the lung is classified to code 162.x with the fourth-digit subcategory identifying the specified site of the cancer such as: • 162.0, Trachea • 162.2, Main bronchus • 162.3, Upper lobe, bronchus or lung • 162.4, Middle lobe, bronchus or lung • 162.5, Lower lobe, bronchus or lung • 162.8, Other parts of bronchus or lung — includes malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined • 162.9, Bronchus and lung, unspecified Carcinoma in situ of the lung is classified to code 231.2. Nonmalignant neoplasms of the lung are classified to code 212.3 for benign, code 235.7 for uncertain behavior, and code 239.1 for unspecified nature. If the lung cancer is considered a metastatic site—in other words, the cancer spread from another organ to the lung—code 197.0 is assigned. Symptoms • coughing—a new cough or cough that does not go away; • hemoptysis; • chest pain; • shoulder or back pain — made worse by deep breathing; • shortness of breath; • recurrent pneumonia; • hoarseness; • difficulty swallowing; • swelling in the neck, face, and upper extremities; • fatigue/weakness; • loss of appetite; and • weight loss. Advanced lung cancer eventually metastasizes to nearby lymph nodes or other tissues in the chest, including the other lung. In many cases, lung cancer is also spread to other organs such as bone (198.5), brain (198.3), liver (197.7), and adrenal glands (198.7). Diagnosis • Physical exams identify lymph node enlargement in the neck or the region above the collarbone, liver enlargement, abnormal abdominal enlargement, and signs of lung mass. • Chest x-rays show growth and find location. • Pulmonary function tests indicate a narrowing or obstruction in the airways. • Sputum cultures detect cancerous cells. • Biopsies confirm cancerous cells. The biopsy may be performed through a bronchoscopy (33.24), percutaneous needle biopsy (33.26), or thoracoscopy (33.26 if by needle or 33.28). Transbronchial lung biopsy (33.27) is when the bronchoscope biopsy forceps actually punctures the terminal bronchus and samples of the peribronchial alveoli (lung tissue) are taken. The coder should read the operative report completely to determine the procedure performed prior to code assignment. • Thoracentesis (34.91) identifies cancerous cells in the fluid of the chest cavity. Staging • limited — cancer is confined to one lung and to its neighboring lymph nodes; or • extensive — cancer is spread beyond one lung and its neighboring lymph nodes, possibly invading both lungs, more remote lymph nodes, or other organs. Non-SCLC is staged according to tumor size, level of lymph node involvement, and extent of distant metastases. Stages include the following: • Stage 0 — limited to lining of air passages and hasn’t invaded lung tissue; • Stage I — spread to layers of lung tissue; • Stage II — invaded neighboring lymph nodes or spread to the chest wall; • Stage IIIA — spread from lung to lymph nodes beyond the lung area; • Stage IIIB — spread to areas such as the heart, blood vessels, trachea, and esophagus—all within the chest; and • Stage IV — spread to other parts of the body such as the liver, bone, and brain. Treatment • Wedge resection (32.29) is the removal of a small portion of the affected lung. This procedure should not be confused with a wedge biopsy of the lung (33.28), which is the removal of a small sample of lung tissue for microscopic examination (AHA Coding Clinic for ICD-9-CM, 1999, third quarter, pages 3-4). • Segmental resection (32.3) is the removal of a small portion of the lung. • Lobectomy (32.4) is the removal of the entire lobe of the lung. • Pneumonectomy (32.5) is the removal of the entire right or left lung. Coding and sequencing for lung 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 Health Information Systems (800-367-2447), a supplier of coding and classification systems to more than 5,000 customers worldwide. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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