Carcinoma in situ, any site
|Dx:||Carcinoma in situ, any site|
|Pre-ICD10 counterpart:||none assigned|
|APACHE Como Component:||none|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
Carcinoma in situ
- Carcinoma in situ (CIS), also known as in situ neoplasm, is a group of abnormal cells. While they are a form of neoplasm, there is disagreement over whether CIS should be classified as cancer. This controversy also depends on the exact CIS in question (i.e. cervical, skin, breast). Some authors do not classify them as cancer, however, recognizing that they can potentially become cancer. Others classify certain types as a non-invasive form of cancer. The term "pre-cancer" has also been used.
- These abnormal cells grow in their normal place, thus "in situ" (from Latin for "in its place"). For example, carcinoma in situ of the skin, also called Bowen's disease, is the accumulation of dysplastic epidermal cells within the epidermis only, that has failed to penetrate into the deeper dermis. For this reason, CIS will usually not form a tumor. Rather, the lesion is flat (in the skin, cervix, etc.) or follows the existing architecture of the organ (in the breast, lung, etc.). Exceptions include CIS of the colon (polyps), the bladder (preinvasive papillary cancer), or the breast (ductal carcinoma in situ or lobular carcinoma in situ).
- Many forms of CIS have a high probability of progression into cancer, and therefore removal may be recommended; however, progression of CIS is known to be highly variable and not all CIS becomes invasive cancer.
- In the TNM classification, carcinoma in situ is reported as TisN0M0 (stage 0).
Using ICD10 Malignancy Codes as a Comorbid Diagnosis
- Any cancer/malignancy (either a "solid tumor" or a leukemia/lymphoma/bone marrow malignancy/"liquid tumor", i.e. any ICD10 code from C00-C99) can be a comorbid diagnosis --- BUT it's vital to distinguish malignancies in this category based on whether they are believed to be cured or not.
- If it's still present (or believed to be present), then just include the code for the specific cancer as a comorbid diagnosis.
- If INSTEAD, it's presumed cured, then in the "bin" of comorbid diagnoses combine the code for the specific cancer with this code: Past history, cancer (any type), believed cured
Regarding Presumptive Diagnosis of Malignancy
- Rarely a presumptive diagnosis is made without any tissue confirmation. This generally occurs with:
- risk of obtaining tissue is very high
- plan would be palliative regardless
- patient would refuse care regardless.
- Our issue for how to code a presumed malignancy without definitive histopathologic proof is this:
- If the physicians are going to proceed with a treatment plan without that definitive histopathologic proof --- then code whatever is their best guess about what is present. Example: believed to be lung cancer with a big brain met, and they've decided NOT to do any biopsy but to give palliative radiation therapy, then you'd code lung cancer, and met to brain.
- If the plan is to obtain a definitive histopathologic diagnosis soon or in the future, then instead code: Neoplasm of uncertain behavior (i.e. not clear if benign or malignant), NOS
"work-up for cancer"
If the cancer has not been confirmed then it should not be coded as cancer. Code relevant test abnormal test results or symptoms.
"I have a patient who comes in with vague respiratory and gi symptoms. They did a chest xray and found a lung mass. They are now working him up for a probable lung ca, with mets to various places. In the old coding I would use ca-nyd. I actually use the ca nyd subcode a lot. I’ve talked to you about this before, because there is no ca nyd in icd10. You told me that you either have cancer or you don’t. For this particular patient I really wouldn’t have anything else I could code in icd10 for him. His symptoms are extremely vague. I don’t really like coding just symptoms, if there isn’t a proper admit diagnosis that fits better anyway. I found a “neoplasm of uncertain behavior (i.e. uncertain if benign or malignant), nos”, but I don’t really like that one. It doesn’t really fit. Is it possible to get something like “admit for workup of malignancy”, or something along those lines?" (Debbie, 12:40, 2018 October 4 (CDT)) How should this be coded? Ttenbergen 12:40, 2018 October 4 (CDT)
Alternate ICD10s to consider coding instead or in addition
Candidate Combined ICD10 codes
Related CCI Codes
Data Integrity Checks (SMW)