Lung nodule

JCB1020JCB1020
in Home Care Coding General
Question on a patient with a lung nodule identified on a Pet scan. Patient had surgical lung resection to address the lung nodule and also lymph node sampling. Outcome of testing is pending. Is this a neoplasm of uncertain behavior of lung? A solitary pulmonary nodule or just a lung mass? Also, For homecare, would we use primary Aftercare for Neoplasm surgery? Or Aftercare for surgery on Respiratory?
Any help is greatly appreciated..
Thanks!!

Jaycee Barkasi
OASIS Coordinator, Clover/East team
Gallagher Home Health Services
412-279-7800 X2504
412-446-0446
jbarkasi@gallagherhhs.com

Comments

  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    A neoplasm can be malignant or benign. Neoplasm means an unusual growth, not supposed to be there.
    The harvest of the adjacent nodes are to rule out metastatic disease.
    A lung mass, lung nodule, pulmonary nodule are all neoplasms of uncertain behavior until the path ID's it.
    Yes, you will use the AC following neoplasm surgery

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Good morning Lisa.
    The Nat'l Cancer Institute's definition:
    neoplasm (NEE-oh-PLA-zum)
    An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Neoplasms may be benign (not cancer), or malignant (cancer). Also called tumor.

    I had a patient, an elderly lady cared for by her daughters, and I gave her monthly B12 injections and had HH Aides for personal care as she was essentially bedbound.
    One day the Aides found a very large palpable mass in her breast. It was reported to her physician and he of course recommended immediate workup beginning with a biopsy, and he stated that he suspected breast cancer. The daughters refused workup as they did not want to put their elderly mother through the medical intervention.
    That would be coded as a neoplasm of uncertain behavior as the physician documented R/O breast cancer.
    Now if the mass had no physician documentation of suspected cancer, then the choice would be a code from D49 category.
    Per the Coding Center:
    Notes (D49)

    Category D49 classifies by site neoplasms of unspecified morphology and behavior. The term 'mass', unless otherwise stated, is not to be regarded as a neoplastic growth.

    This Note (D49) conflicts with the Cancer Institute's definition of "mass". On the other hand, an abdominal mass on x-ray can turn out to be an abscess which is neither a benign or malignant process. Notice that D49 is in Chapter 2 titled "Neoplasms", yet has a code in that chapter that "is not to be regarded as a neoplastic growth".
    Figure that one out?

    In the case presented on the List Serve, I opinioned that the lymph node harvest is performed to R/O metastatic disease because if a (D49) "mass" is excised, then the surgeon does not "harvest" lymph nodes, they just remove the mass.
    Mine is strictly opinionated from my years of surgery experience, no more.
    One does not have the luxury of medical records to examine when responding to inquiries on the List Serve.
    My humble opinions to quoted material. Good luck on making your decision when it comes at you.
    I would look for physician documentation of "suspect' and "R/O (rule out)" when deciding which of the two to use.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
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