AHA Coding Clinic® for ICD-9 - 2006 Issue 3; Ask the Editor

Malignancy of Right Main Lobe and Right Bronchus

A patient with advanced lung cancer, status post right upper lobectomy, is admitted for work-up due to increasing shortness of breath. During this admission, a bronchoscopy with biopsy is performed that showed an endobronchial tumor at the level of the right main bronchus extending to the right upper lobe bronchus with metastatic spread to mediastinum and intrathoracic lymph nodes. The patient expired during attempted tumor debridement, prior to the completion of the procedure. What is the correct diagnosis code assignment? Is it appropriate to use two separate codes for the separate location of the tumors or is this considered to be contiguous sites requiring the fifth digit of “8”? Coding Clinic defines contiguous sites (fourth digit “8”) as a primary malignant neoplasm that overlaps the boundaries of two or more subcategories within a three-digit category and whose point of origin cannot be determined. ...

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