Neo means new and plasm means growth. Neoplasm is a type of cancer. Cancer of 2 types benign and malignant.

Benign:- Tumor that doesn’t spread and can be cured by excision {surgical removal}

Malignant:- Tumor that spread, there will be continuous growth and difficulty to cure. The spreading of tumor is known as metastasis. It spread through blood and lymph fluid.

  Coding Rules:-

  1^st indentified the behavior.

2^nd locate the site.

  Neoplasm behavior:- ICD-9-CM classifies malignant neoplasm as primary, secondary and carcinoma in situ.

  Primary:- identifies the site{location} of origin of the neoplasm. Determination of patient’s origin and type of cells is important to find the severity of illness and planning treatment.

  Secondary:- indentifies the site to which the primary site has spread by direct extension to surrounding tissues.

  Carcinoma in situ:- it doesn’t spread beyond the point of origin { it’s a tumor cells which are undergoing malignant changes, these changes don’t extend}

  Uncertain behavior:- not yet tested. {tumors which show features of both benign and malignant behavior.

  Metastatic from and of :- site is primary

Metastatic to:- site is secondary

Assign the code 199.1 when secondary site is not mentioned.

For examples:-

  Metastatic carcinoma to the liver

Px: primary site           Sx: secondary site

Code:  Px: 199.1          Sx: 197.7

Metastatic carcinoma of the pancreas

Code:  Px: 157.9            Sx: 199.1

  Metastatic carcinoma from the breast

Code:   Px: 174.9               Sx: 199.1

  Metastatic carcinoma of brain and lung

Code brain and lung as secondary site,  assign the code 199.1 as primary site is not specified.

Codes:-        Px: 199.1

                     Sx 1: 198.3 {brain}

                     Sx 2: 197.0 {lung}

  Metastatic renal cell carcinoma of the lung

Code first primary site as renal cell carcinoma then code Secondary site as lung.

Codes:                Px: 189.0 {renal cell}

                     Sx: 197.0 {lung}

Carcinoma of the oral cavity and pharynx

Notes: when the patient of origin can’t be determined because the neoplasm overlaps the boundaries of 2 or more contiguous [adjacent] site, it’s classified to 4^th digit “8”

Code: 149.8 [Malignant neoplasm of lip, oral cavity and pharynx whose point of origin can’t be assigned to any one of the categories.]

Metastatic carcinoma of retroperitoneum and peritoneum

Code:           Px: 199.1

Sx: 197.6 [retro+ peritoneum code only once]

Metastatic carcinoma of the ovary

  Code:           Px: 183.0

Sx; 199.1