Q: Can you explain when a neoplasm should be listed as the principal diagnosis? We have some coders who believe the neoplasm should always be the principal diagnosis.
A: No coding guideline says that a neoplasm takes precedence. Recognizing the focus of treatment is really what helps the coder figure out what the principal diagnosis should be, and this is all discussed in Coding Clinic, Second Quarter 2010, p. 3.
It is sometimes a challenge for the coder because cancer or neoplastic diseases often cause multiple secondary conditions to occur. Trying to dig through all of that information to come to a principal diagnosis is what makes this a somewhat challenging process.
For example, a patient was admitted for hypercalcemia related to her multiple myeloma. The focus of treatment for this visit was correcting the hypercalcemia. The physician didn’t treat the multiple myeloma at all. Oftentimes patients with metastatic or malignant cancers are being treated for their symptomology to help ease them and provide comfort prior to being released to hospice.
Coding Clinic, Third Quarter 2012, p. 16, covers this specific example. Because the physician wasn’t treating the malignancy during the acute inpatient admission, the hypercalcemia actually would be principal.
Editor’s note: Heather Taillon, RHIA, manager of corporate coding support services at Franciscan St. Francis Health in Indianapolis, answered this question.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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