Coding, Classification & Reimbursement

Coding Tumor

  • 1.  Coding Tumor

    Posted 11-07-2018 12:19
    Can someone code ileal carcinoid with metastasis to the liver. I got D49.0 with C787, but since benign carcinoid tumors do not spread to other parts of the body would it be right to code C7A.012 with C787. I think the metastasis should be coded to C787, because it was not worded as ileal with metastasis to the liver carcinoid.

    Wendy Johnson
    Medical Coder
    Chicot Memorial Hospital

  • 2.  RE: Coding Tumor

    Posted 11-08-2018 05:37
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    You said code "ileal carcinoid with metastasis to the liver". You didn't say benign or malignant, you can't assume one or the other. Did you query the MD and confirm whether the ileal carcinoid was benign or malignant? Since the MD states with mets one would assume it is malignant but you should confirm first. Carcinoids are rare slow growing cancers. It is very common for them to spread to the liver.



    Brenda Mohs, RHIT

    Home Health & LTC Medical Coder

    Essentia Health



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  • 3.  RE: Coding Tumor

    Posted 11-09-2018 08:03
    ​Benign tumors do not metastasize.  It the tumor has spread to the liver as indicated in the provider's diagnostic impression, that makes it malignant.


  • 4.  RE: Coding Tumor

    Posted 11-08-2018 07:33

    D49.0 identifies neoplasm of unspecified behavior of the digestive system, and not a carcinoid tumor.  Carcinoid tumors do have the ability to spread if it is malignant. The fact that you stated the diagnosis as "ileal carcinoid with metastasis to the liver" makes it malignant and not benign.  As stated, your codes would be C7A.012 - Malignant carcinoid tumor of the ileum and C7B.02 - Secondary carcinoid tumor of the liver.


  • 5.  RE: Coding Tumor

    Posted 11-08-2018 12:49
    Thanks both of you for responding, I was thinking the same thing about Malignant, but was not sure about the secondary code. I got D49.0 from the book for the first list code under Tumor ( see also Neoplasm, unspecified behavior, by site).


  • 6.  RE: Coding Tumor

    Posted 11-09-2018 09:46
    I agree with Lee Julien-Williams.  The statement "ileal carcinoid with metastasis to the liver" indicates carcinoid metastasis from ileum to liver. Carcinoid malignancies aren't going to metastasize as another type of carcinoma and an unspecified or other type of metastasis code should not be used.
    Laura C Jones, RHIT, CCS
    ICD-10-CM/PCS Coding Validator

  • 7.  RE: Coding Tumor

    Posted 11-09-2018 10:29
    I agree with Lee and Laura, that benign tumors don't spread and the physician indicated that it metastasis to the liver, so that tells me that tumor is Malignant and the liver would be secondary. I don't think we would have to query a physician to tell us that the tumor was Malignant.

  • 8.  RE: Coding Tumor

    Posted 11-08-2018 18:17

    Hi Wendy,

    I have the same thought regarding "ileal carcinoid with metastasis to the liver" in that it is implicit in this diagnostic statement that the ileal carcinoid is malignant primary.  To get to the malignant primary code I would use the main term "carcinoid," and not "tumor," since that is the term the provider used in their diagnostic statement.

    In ICD-10, the term "carcinoid" does not have a default code in the index.  The physician will need to specify the carcinoid as one of the following: benign, malignant primary, or malignant secondary.

    Tumor, carcinoid Carcinoid, tumor

    As for the metastasis to the liver, I can see why you assigned C78.7 Secondary malignant neoplasm of other and unspecified digestive organs, and not C7B.02 Secondary carcinoid tumors of liver, because the physician did not state "metastasis to the liver carcinoid."

    It seems to me that the malignant secondary that is related to carcinoid is specifically identified by category C7B, Secondary neuroendocrine tumors.  You won't find the codes under this category in the Neoplasm Table.  The Neoplasm Table directs the coder to go directly to "tumor, carcinoid" for the main term carcinoid.  The index appears to be the place in which the malignant secondary carcinoid tumors are located.

    When I use the encoder to look up the secondary code, it gives me a code from category C7B. That is the code the software thinks that would be assigned.

    I hope this is helpful.  I'm interested in what others think about indexing the malignant secondary code.

    Cristina Co
    Facility Outpatient Coder