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Coding / Medical Billing

Looking for help with an actual coding question :) - levette

Posted: Dec 13th, 2018 - 10:45 pm

I'm not sure where I can ask coding questions.  I hope there are knowledgable coders reading this forum!

Does anyone know where it states the following sites should be coded as a secondary site when there is a malignant neoplasm not otherwise specified (i.e., it's not specified as a primary or secondary malignant neoplasm)? 





Lymph nodes

Liver (exception)






Spinal cord


A 1985 Coding Clinic states these sites are considered secondary if qualified as metastatic.  But now I'm told "bone cancer" would be considered secondary (per CMS).  So would "brain cancer."  Yet there's a 1994 Coding Clinic article that codes "brain carcinoma" as a primary even though the documentation didn't state it was a primary.  The question&answer above came from The Coding Handbook, but that's hardly an official source for coding.  As CMS is also following this rule, stating it comes from coding guidelines, I'm curious as to the source of this rule (which really should be in our official ICD-10-CM code books by now!).


I went to Andrews and one of the exam questions had to do with malignant neoplasm of the pleura.  I coded as primary and the computer graded that correct.  Yet, pleura is on the list above.  




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