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
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.
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.