Q: Coding Metastatic Breast Cancer Diagnosis – “If the only documentation is metastatic breast, how can I code it like a secondary, or do I code it as a secondary or primary site?”

A: Well, it’s very easy to get confused, like I said, but you have two options with it just saying metastatic breast. You could go with C50.919 – malignant neoplasm of unspecified site, of unspecified female breast. That is an option but a better and the best option is C79.81 – secondary malignant neoplasm of the breast. I’m going to now explain why that’s the best choice.

There’s a coding note that I found that’s really worded well, so I took it from that site. I noted it there. When neoplasms are malignant, you get to review the provider documentation to identify the primary site and any secondary, and notice I put in brackets here (metastatic) sites. Look for documentation that identifies the spread “from” the primary site “to” the secondary site. The reason this really popped for me is because they said secondary metastatic site.

Coding Metastatic Breast Cancer Diagnosis Video

Now, let’s look into this a little bit more, again the footnote on there is a great site. That site is will be in the Replay Club and you can bookmark that site, which is fantastic. As we scroll down here’s a couple other things that I found on this website that again really, really popped for us. What is metastatic cancer? Now, as you’re coding, you learn this very quickly because you’re tested on it. So, one of the things that is covered frequently; however, the lingo and the verbiage sometimes you get kind of confused because they’re throwing all these stuff at you. To metastasize is to move from one place to another, so we’ve already know that. We’ll say that’s something that’s kind of easy to remember.

But what if they say metastatic, well what is metastatic cancer? They go on to tell us that metastatic cancer is a cancer that spread from one place to another. So, metastasis or metastasize, that’s easy to remember. A tumor formed by metastatic cancer cells, so they’re moving, is called metastatic tumor or a metastasis. Now, when the process in which the cancer cells spread to other body parts of the body is called metastasis, or some people say different ways. But, metastatic cancer has the same name as the same type of cancer cells as the original or primary cancer.

Now, as you scroll down just a little bit more, here’s the key, I bolded it for us – For example, breast cancer that spread to the lung and forms a metastatic tumor is metastatic breast cancer, not lung cancer. That throws people, and the way they know this, if we know the behind the scenes, when they actually look at the cells, they go in they look at the cells, the cells stay the same. So, if it’s breast cancer cells – cells that went haywire, no longer doing what they’re supposed to be doing for whatever reason – and it goes into the lung, it’s breast cancer cells in the lung. That’s how they know that the lung is the secondary side.

What happens when you say metastatic cancer cells, and the cells of the original cancer usually have some features that are the same. That was off of Fantastic information there.

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Coding Metastatic Breast Cancer Diagnosis


About the Author:

Alicia has been working in the medical field for over 20 years. She first learned about medical coding while working in a medical records department at a resort town hospital near where she was raised. Through the years she has held several jobs in the medical field from, CNA, EMT, Pharmacy technician and Medial Records Abstractor and Analyst. Outside of the medical field she has worked as a Real Estate agent, and owned her own on-line retail business. The medical field has always been where she felt the most comfortable. Alicia has taught medical coding, billing and medical law and ethics at a private college. She also did contract work in HCC Risk Adjustment and discovered she really enjoyed ICD work. Because she loves to learn Alicia is working towards her Masters in Health Care Administration with an emphasis on education. Having taken many online classes through the years to complete her degree she feels very comfortable with both face to face and on-line learning. Alicia will tell you that not only does she love medical coding but she has a passion for teaching it. Alicia lives in the middle of Texas with her husband who is a Pastor, five of her six children, three dogs and two cats.

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