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Question: How should we code malignant breast cancer with metastasis to liver and bone?

Tennessee Subscriber

Answer: Report the breast cancer first using a primary malignant neoplasm code. You also should report secondary neoplasm codes for liver and bone findings.

Breast: The report should identify the location of the tumor to allow you to use the most specific diagnosis code for that site, such as 174.1 (Malignant neoplasm of central portion of female breast). If documentation doesn't show the specific location, the correct code for the breast cancer is 174.9 (Malignant neoplasm of breast [female] unspecified site). Under ICD-10-CM, the code will vary based on the breast involved (for example, C50.111, Malignant neoplasm of central portion of right female breast).

Metastatic sites: You also should code the metastatic cancer noted in the report. You mentioned liver, which you should report as 197.7 (Malignant neoplasm of liver secondary). For the bone metastasis, report 198.5 (Secondary malignant neoplasm of bone and bone marrow). Under ICD-10-CM, look to C78.7 (Secondary malignant neoplasm of liver and intrahepatic bile duct) and C79.51 (Secondary malignant neoplasm of bone) or C79.52 (Secondary malignant neoplasm of bone marrow).

Remember: You should report only confirmed diagnoses. Section IV.I of the ICD-9-CM Official Guidelines for Coding and Reporting states that for outpatient claims, Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,' 'rule out,' or 'working diagnosis' or other similar terms indicating uncertainty.

Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit (