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Cracking the Code

Signs and symptoms vs pain related to neoplasm conditions

It is very important for coders to pay attention to the documentation when coding neoplasm accounts. There are two sets of instructions in the coding guidelines specifically pertaining to how to report signs and symptoms associated with neoplasms and pain associated with neoplasms. Section I.C.2.g. of the coding guidelines state symptoms, signs, and ill-defined conditions that are listed in Chapter 18 or are associated with an existing primary or secondary malignancy site CANNOT be used to replace the malignancy as principal diagnosis.  It does not matter how many times the patient is admitted or treated for the sign or symptom. The malignancy should be reported as the principal diagnosis.

However, if the patient has related pain associated or due to primary or secondary malignancy, then this condition CAN be assigned as the principal diagnosis when the reason for the admission is documented as pain control/management. Per coding guidelines in section I.C.6.b.5., if the documentation supports the patient being admitted and treated for the pain of the neoplasm, then it is appropriate to assign G89.3 as the principal diagnosis followed by the underlying neoplasm as a secondary diagnosis. If the documentation supports the neoplasm as the reason for admission and treatment and the pain is also documented, then it is appropriate to assign the neoplasm as the principal diagnosis followed by the associated pain as a secondary diagnosis.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Section I.C.2.g. and I.C.6.b.5.
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