Coding, Classification & Reimbursement

1.  Complications of Neoplasms. Some

Posted 06-10-2016 19:13
I am finding a difference of opinion among Sezecoders as to which diagnosis to sequence as the principle when you have complications of neoplasms. I interpret the new guidelines to mean the complication should be sequenced as the principal when the treatment is directed at the complication only. I understand anemia is an exception. I am interpreting this to mean bowel/ureteral obstructions are now to be sequenced as the principal. Seizure disorder due to brain mets has also been questioned. Some cite old Coding Clinics as rationale for sequencing the neoplasm as the principle diagnosis. What are your thoughts? Has anyone posed this question to Coding Clinic and received an answer? Thanks for your help!

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2.  RE: Complications of Neoplasms. Some

Posted 06-10-2016 23:02

Hi. Just saw your question RE SBO due to neoplasm. If you follow the indexing for bowel obstruction in ICD-10, it appears that you would code K56.69, other specified obstruction, for intestinal obstruction due neoplasm and code the neoplasm as secondary in view of the Coding Clinic advice to code the complication first. However, for K56.69, there is an Excludes 1 note in the tabular. The coder is directed: Excludes 1: intestinal obstruction due to specified condition--code to condition. By this direction, one would code only the neoplasm and not a code for the obstruction. Since this goes against every coding instinct I have, I did write Coding Clinic at the end of December, 2015, about obstruction due to peritoneal carcinomatosis and sequencing. I received a response on May 12, 2016, to "assign a code for the malignancy only for bowel obstruction due to peritoneal carcinomatosis. In ICD-10, when a pt is admitted with intestinal obstr due to a malign., assign a code for the malign. only as instructed by the Excludes 1 note found under category K56.6, Other and unsp. instinal obstr, which states "intest obstr due to specified condition-code to condition." Although the neoplasm guidelines indicate that the complication of the neoplasm should be coded first, the Excludes 1 note provides sequencing direction and takes precedence." Baffling Excludes 1 note, baffling Coding Clinic. I did ask that my question be published, but apparently it did not make the cut, unless it might appear in 2016 Q2. Hope this helps with your bowel obstruction due to neoplasm question. On the seizure due to brain CA, if the seizure would be coded as a symptom code, I would think you would circle back to the neoplasm because symptoms cannot replace the neoplasm code as Pdx, per coding guidelines. If patient is dx'd with epilepsy or seizure disorder and that is focus of treatment, would think that the seizure disorder would be Pdx. This response is totally without research so maybe others have better input for you on that one. Bye for now.


Josephine Scott RHIT
IP Coding Trainer/Auditor

3.  RE: Complications of Neoplasms. Some

Posted 05-19-2017 18:15
Is this still the answer if the original neoplasm is no longer there?  The blockage is now scar tissue that built up after surgery.

Daniel Clark

4.  RE: Complications of Neoplasms. Some

Posted 05-20-2017 11:13


No if the neoplasm is removed and there's no reoccurrence, then you would not code the SBO to the neoplasm. You may be coding a postprocedural intestinal obstruction (K91.3) but that's with a grain of salt since I'm not reviewing documentation for that answer. The neoplasm would be coded as "hx of".

Kathy Pelanek, RHIT
Coding Educator/Team Lead