Coding for Brain Tumor
For The Record
Vol. 17 No. 21 P. 60
A brain tumor is a mass or growth of abnormal cells in the tissues of the brain. Primary brain tumors may be benign or malignant tumors that originate in the brain. Malignant primary brain tumors are classified to AHA Coding Clinic for ICD-9-CM category 191. The fourth-digit subcategory identifies the part of the brain involved:
191.0, Cerebrum, except lobes and ventricles (includes basal ganglia, unspecified lobe of cerebral cortex, corpus striatum, globus pallidus, hypothalamus, and thalamus)
191.1, Frontal lobe
191.2, Temporal lobe, which includes hippocampus and uncus
191.3, Parietal lobe
191.4, Occipital lobe
191.5, Ventricles, which includes choroids plexus and ventricle floor
191.6, Cerebellum, not otherwise specified, which includes cerebellopontine angle
191.8, Other parts of brain, which includes corpus callosum and tapetum (This code also includes a malignant neoplasm of contiguous or overlapping sites of the brain whose point of origin cannot be determined.)
191.9, Brain unspecified and cranial fossa unspecified
Benign neoplasms of the brain are classified to code 225.0.
Secondary brain tumors (198.3), which are more common, start somewhere else in the body and spread (metastasize) to the brain.
Signs and Symptoms
The signs and symptoms of a brain tumor, which depend on the size, location, and rate of growth, may include the following:
frequent headaches, especially after sleep;
unexplained nausea and vomiting;
vision problems;
loss of sensation or movement in arm or leg;
balance problems;
speech problems;
hearing problems;
confusion;
personality/behavior changes;
seizures;
loss of appetite; and
hormonal disorders.
Grading System
The following is a common system used to grade brain tumors:
Grade I - the tumor grows slowly and rarely spreads to nearby tissue (It may be possible to remove the entire tumor with surgery.);
Grade II - the tumor grows slowly and may spread into nearby tissue (It is possible that it may become a higher-grade tumor.);
Grade III - the tumor grows quickly and is likely to spread to nearby tissues; and
Grade IV - the tumor grows aggressively and is difficult to treat.
There is not a standard staging system available for brain tumors.
Types of Brain Tumors
The following are common types of brain tumors:
Brain stem gliomas are high-grade tumors that form in the brain stem.
Pineal astrocytic tumors form near or in the pineal gland.
Pilocytic astrocytoma (Grade I) starts in the brain cells called astrocytes.
Diffuse astrocytoma (Grade II) grows slowly and spreads into nearby tissues.
Anaplastic astrocytoma (Grade III) is also known as malignant astrocytomas.
Glioblastoma (Grade IV)-also called glioblastoma multiforme and Grade IV astrocytoma-are malignant astrocytomas that grow and spread aggressively.
Oligodendroglial tumors originate in brain cells called oligodendrocytes and have two grades: oligodendroglima (Grade II) and anaplastic okiogodendroglioma (Grade III).
Mixed gliomas contain more than one type of cell and are classified into two grades: oligoastrocytoma (Grade II) and anaplastic oligoastrocytoma (Grade III).
Ependymal tumors originate in cells that line the spaces in the brain and around the spinal cord. Grades include Grade I and Grade II ependymomas and anaplastic ependymoma (Grade III).
Medulloblastoma (Grade IV) begin in the lower part of the brain.
Pineal parenchymal tumors form from parenchymal cells or pinocytes. Grades include pineocytomas (Grade III) and pineoblastomas (Grade IV).
Meningeal tumors form in the meninges and grades include Grade I meningioma and Grade II, and Grade III meningiomas and hemangiopericytomas.
Germ cell tumors form from germ cells.
Craniopharyngioma (Grade II) occur in the sellar region of the brain near the pituitary gland.
Code assignment for the above types of brain tumors will depend on the site of the tumor and whether the tumor is primary, secondary, or benign. A tumor of the meninges in the brain is classified to the following codes:
192.1, Primary malignancy;
198.4, Secondary malignancy; and
225.2, Benign neoplasm.
A tumor of the pineal gland is classified to the following codes:
194.4, Primary malignancy;
198.89, Secondary malignancy;
234.8, Carcinoma in situ; and
227.4, Benign neoplasm.
Diagnosis
If a physician suspects a brain tumor, he or she will perform a neurologic exam to check vision, hearing, balance, coordination, and reflexes. If the patient fails the exam, the physician will order one or more of the following diagnostic studies:
computerized tomography scan;
magnetic resonance imaging;
angiogram;
x-ray of the head and skull;
magnetic resonance spectroscopy;
single-photon emission computerized tomography;
positron emission tomography scan; and
biopsy of brain tissue.
Treatment
Treatment of a brain tumor depends on the type, size, grade, and location of the tumor. The patient may receive one or a combination of the following:
surgery;
radiation therapy; and
chemotherapy.
Coding and sequencing for brain tumors 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 nearly 5,000 healthcare providers. 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.
