The Neoplasm Table of the ICD-9-CM diagnostic coding book has a mystique about for those who attempt to use it. The assumption is made, often correctly, that those working in certain disciplines, say for an oncology practice, must be proficient at locating diagnosis codes. For the infrequent or new user, it can be an intimidating section of the coding book to turn to. I call it the "Six Columns of Confusion."

Just at the start, I want to say that I "never" think of using a code that has involved the Neoplasm Table without a pathology report, with one exception. Why? Because the decision of what the CELL types are and their behavior is best discerned by a pathologist, not by the physician doing the surgery. The pathologists' job is to identify the cells, diagnosis any disease and document the extent of it, according to Jim Richards, D.O., a Cleveland Clinic trained and Board Certified Pathologist. My one exception regards when the "growth" is destroyed and there is no tissue to examine. This might be the case with skin lesions that are removed by electrocautery destruction. What do I use then? I rely on the attending physician to document in the medical record his diagnosis of what the "growth" was.

The word "neoplasm" comes from Greek roots for "new growth." Neoplasm is commonly considered synonymous to the word "tumor," which is explained as tissue or cells that grow abnormally. When you search other definitions of neoplasm on the Internet you find several slightly different interpretations of what this singular word means. These vary from an abnormal overgrowth of cells rather than healthy new cell growth, to abnormal proliferation of cells in a tissue or organ. Dorland's Medical Dictionary, which is many physician's first choice in references for this type of discussion, states that a neoplasm is "any new and abnormal growth; specifically a new growth of tissue in which the growth is uncontrolled and progressive."

Why all this concern for the definition of neoplasm? The choice of a diagnosis code from the Neoplasm Table has implications that must be considered. You MUST be sure that your code choice is as correct as it can be. You would never want to assign someone a disease or a cancer they do not have just because you accidentally selected the wrong line or wrong column of the Table. Or worse, that you used the Neoplasm Table when you should not have, when a more specific code was available for that diagnosis: perhaps, one that was NOT even listed as a part of the Table.
Understanding that not all tumors can be found in the Neoplasm Table is your first reminder of how to properly use it. The Neoplasm Table is an incorrect place to start, and it can take you in a direction that is incorrect, wasting valuable time on the way and adding an opportunity for errors. Guidelines from ICD-9-CM (Section C-2) tell us to look at what has been documented in the record and look FIRST to the Alphabetic Index. Some benign neoplasms may be found in the specific body system chapters rather than in the neoplasm chapter.

Try it yourself. Look up "prostate adenoma" in the alphabetic index (Volume II) of your ICD-9 coding book. You will see you are NOT sent to the Neoplasm Table but rather to 600.20. When you go to this number in Volume I of your ICD-9, you find it corresponds to a code in the "Diseases of the Male Genital Organs (600-608)" section. Specifically, "Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms [LUTS] - benign localized hyperplasia of prostate NOS. "

Now if you look up "prostate" on the Neoplasm Table your next decision is what column to choose from. If you happen to know that an adenoma is considered a "benign" tumor you can find 222.2. This is the listing in the "benign" column of the Table (4th column from the left) under Prostate (gland). Verifying this number, 222.2, in Volume I of your ICD-9 book takes you to a listing for "Benign neoplasm of the male genital organs/prostate". So you think you are fine. But reading further you see that the 222.2 code specifically excludes prostatic adenomas and lists 600.20-600.21 as their codes.

So our first and very important step in the use of the Neoplasm Table is to be sure we need to even use the table. When we go back to the basics, to the conventions and rules of coding, we find the basis for potential errors that are significant. Don't let the Neoplasm Table confuse you before you even get to those "Columns of Confusion." Get off to the right start.

Jill Young, CPC, CPC-ED, CPC-IM, is the principle of Young Medical Consulting, LLC. She has been in medical coding and reimbursement for 30 years. Her consulting company also provides education and training from front office to back. She is a member of the American Academy of Professional Coders Local Chapter Association (AAPCCA). AAPC (www.aapc.com), the nation's largest medical coding training and certification association for medical coders, provides certified credentials to medical coders in physician offices, hospitals and outpatient centers. The three certifications AAPC offers are CPC®, CPC-H® and CPC-P® and represent the gold standard certification for medical coding. Jill lectures nationally for the AAPC and for the Michigan State Medical Society. She has been a speaker at the AAPC National Conference for five years, this year presenting on the Neoplasm Table topic in Orlando.