BLOC ASSIGNMENT 42 CODE

BLOC ASSIGNMENT 42 CODE

Coding guidelines state: When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.įor the procedure, the correct root operation is resection since the physician documented in the op note “proceeded to remove all nodal tissue en bloc.” One participant in this coding challenge asked if a second procedure code, specifically the code for excision with qualifier of diagnostic, is needed to identify the fact that the lymph node tissue was sent for pathology review. Treatment of the abdominal site may or may not be ongoing however, it was not the focus of this encounter. We don’t know the status of the melanoma of the abdomen, other than it has been excised. At that point, we oriented the specimen and sent it for final pathology review.”Īssign only the ICD-10 diagnosis code for the reason for the surgery and the ICD-10-PCS code for the removal of the lymph node tissue.Ĭ774 Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodesĠ7TJ0ZZ Resection of left inguinal lymphatic, Open Approachĭuring this encounter, treatment was directed at the secondary malignant site of the left inguinal lymph node, so C774 should be sequenced as the principal or first listed diagnosis, i.e., the reason for the surgery. The physician also noted in the op note: “We continued with our dissection more inferiorly and connected the specimen between the two incisions at a level above the inguinal ligament and proceeded to remove all nodal tissue en bloc. Given these findings, she was readmitted for superficial inguinal lymph node removal of the left groin.” Of note, her sentinel lymph node localized to the left lower groin. She underwent a sentinel lymph node biopsy and wide local excision of the previous tumor and unfortunately, the pathology showed positive 4.3 cm lymph node with extracapsular extension. According to the operative note: “This is a very pleasant 42-year-old female who, unfortunately, was found to have an intermediate thickness melanoma with a Breslow depth of 2.7 mm located on her abdomen in the left lower quadrant. Patient had a melanoma of the abdomen excised on a previous admission and is admitted now for superficial groin dissection of sentinel lymph node. Julia Palmer, project manager with the consulting services business of 3M Health Information Systems, is author of this month’s coding challenge blog. ICD-10 coding challenge: Removal of lymph node tissue

Bloc assignment 42