HS317b - Coding & Classification of Health Information
Lab Session - Neoplasms

Skin rule - #
Squamous Cell carcinoma of the foot apply the skin rule and look for #
M
4
C44.7
8070/3
o Folio Lookup – Neoplastic – back – “back NEC #”
o If morphology is squamous cell carcinoma or epidermoid carcinoma, sites
marked with the # sign in the Neoplasm Table must be classified to
malignant neoplasm of the skin of the site
o If the morphology is papilloma (any type), sites marked with the # sign
must be classified to benign neoplasm of the skin of the site.
o Example:
 Epidermoid carcinoma of the back.
 Papilloma of the leg

Bone rule –
Adenocarcinoma of femur
M
C79.5
4
8140/6
3
C80
8140/3
o Primary neoplasms of the bone would have a morphology of
 intraosseous carcinoma/adenocarcinoma or
 odontogenic carcinoma/adenocarcinoma.
 If the morphology is carcinoma or adenocarcinoma of any type
other than intraosseous or odontogenic, it is presumed to be
metastatic
 The neoplasm is coded as secondary C79.5. The sites
where this rule applies are marked with a diamond sign.
o The sites where this rule applies are marked with a diamond sign.
o Example:
 intraosseous carcinoma of femur C40.2
 Carcinoma of femur C79.5

Connective Tissue Rule
Fibrosarcoma of the spleen
M
C26.1
4
8810/3
See Neoplasm table, connective tissue, malignant. Since “spleen” does not appear
under connective tissue in the neoplasm table” code to neoplasm, spleen (not C49.9)
HS317b - Coding & Classification of Health Information
Lab Session - Neoplasms
o For neoplasms of connective tissue (blood vessels, bursa, fascia, ligament,
muscle, peripheral nerves, sympathetic and parasympathetic nerves and
ganglia, synovia, tendon, etc) code to sites listed under connective tissue
in the neoplastic Table
o If a site does not appear in the list, code to neoplasm of that site.
o Example
 Fibrosarcoma, retroperitoneum – C48.0
Non-Hodgkin’s lymphoma with “metastasis to inguinal nodes”
M
4
C85.9
9591/3
“Metastasis” used with lymphoma is not the same as for solid tumours; no matter how
many sites are involved, all is included in C85.9
In a subsequent admission to hospital, the above patient underwent modified radical
mastectomy with total axillary node dissection (no tissue graft). Pathology reported
infiltrating duct carcinoma of the breast with metastasis to 2 lymph nodes
M
4
3
4
C50.81
8500/3
C77.3
8500/6
1.M.91.LA
-
L
/
A patient who had a previous excisional biopsy of a right breast lump which was positive
for infiltrating ductal carcinoma, was admitted for mastectomy and lymph node
dissection (one incision) with local flap closure and implantation of tissue expander. The
path report showed breast tissue with no evidence of malignancy and negative lymph
nodes.
M
4
C50.90
8500/3
1.YM.92.LA-TP-E
-
R
/
Breast and lymph tissue, same incision = radical excision
Excision:
Partial:
Total:
any part of an organ or body part is removed
when the entire organ or part is removed
HS317b - Coding & Classification of Health Information
Lab Session - Neoplasms
Radical:
total removal of a body part (usually) along with the removal of structures
from another body system.
Repair versus reconstruction
Debridement
 When it is done to prepare a site for grafting (identified as excisional) the
Debridement is considered to be part of ‘repair’
 When it is a simple Debridement (non-excisional) included under destruction
 Done with temporary coverage of an anatomy site by dermagraft, xenograft ora
dressing that contains maggot/larval therapy is included in Dressing, skin by site.
Grafts:
Autograft:
Tissue from patient’s own body and having no vascular supply. Also
referred to as autologous tissue
Homograft
organ or tissue procured from another human being and may be used
promptly after procurement or after preservation in a tissue bank. Also referred to as
allograft, allogeneic organ or homologous tissue
Xenograft:
organ or tissue procured from an animal source. May also be referred to
as heterograft, heterologus graft or heteroplastic graft.
Local Flap: Tissue is cut on three sides leaving the fourth side attached to its blood and
nerve supply, in the immediate vicinity where the ‘repair’ is needed.
Pedicled:
Prepared like a local flap but needs to be split in order to reach the distant
site and source documentation may refer to tunnelling of the pedicled flap. The pedicled
flap remains attached at its base carrying its own blood supply. When the flap has been
set into the recipient defect site and a new blood supply has been established the pedicle
may be divided.
Free Flap
tissue that is raised on its vascular pedicle, removed from its originating
site and transferred to a new location on the body. These flaps contain vessels to
maintain a blood supply and must be joined at the recipient site by microvascular
anastomosis to allow revascularization.
Diagnostic Interventions
Select a code from rubric 2.~~.70.~~ Inspection, body site only if it is the only
intervention performed.
If a biopsy is taken, the biopsy code is used and the inspection code is not coded.
If an excision biopsy is done, then excision, partial body site is coded and not the biopsy
code.
The endoscopy becomes the approach (captured via the qualifier field) for many
diagnostic interventions.