KODING DENGAN

ICD-O
NUNGKI ANGGOROWATI
DEPARTEMEN PATOLOGI ANATOMI FK UGM
ICD-O-3 TOPOGRAPHY CODING RULES
Rule A. Topography regions and ill-defined sites
Rule B. Prefixes
Rule C. Tumors involving more than one topographic category or subcategory
Rule D. Topography codes for lymphomas
Rule E. Topography codes for leukemias
Rule F. Behavior code in morphology
Rule G. Grading or differentiation code
Rule H. Site-associated morphology terms
Rule J. Compound morphology diagnoses
Rule K. Coding multiple morphology terms
Rule A. Topography regions and ill-
defined sites
If the diagnosis does not specify the tissue of origin, code the
appropriate tissues suggested in the alphabetic index for each ill-
defined site in preference to the “NOS” category.
Example : Squamous cell carcinoma of arm
Squamous cell carcinoma M8070
Arm???
Rule A: topography
region and ill defined
sites
Rule A: topography region and ill
defined sites
Rule A: topography region and ill
defined sites
Arm
Squamous cell carcinoma
Liposarcoma
Malignant lymphoma
Malignant nerve sheath tumor
(peripheral nerve)
Osteosarcoma
Tissue of origin undetermined
C44.6 (skin of arm)
C49.1 (fatty tissue)
C77.3 (LN of arm)
C47.1
C40.0 (bone of arm)
C76.4 (Arm, NOS)
Rule A: topography region and ill
defined sites
Rule B. Prefixes
If a topographic site is modified by a prefix such as peri-,
para-, or the like, which is not specifically listed in ICD-O,
code to the appropriate ill-defined subcategory C76 (ill-
defined site), unless the type indicates origin from a
particular tissue.
Rule B. Prefixes
Example : peri-, para-, pre-, supra-, infra-,
1) suprarenal gland C74.9
(adrenal gland, NOS)
2) para-aortic lymph node C77.2
(aortic lymph node )
3) periadrenal C48.0
perirenal, retrocecal
(retroperitoneum)
A few topographic sites modified by prefixes are listed in ICD-O and given
specific code numbers.
Rule C. Tumors involving more than one
topographic category or subcategory
Use subcategory “.8” when a single tumor overlaps the boundaries
of two or more categories or subcategories and its point of origin
cannot be determined.
Rule C. Tumors involving more than one
topographic category or subcategory
Site code Description
C02.8 Overlapping lesion of tongue
C08.8 Overlapping lesion of major salivary gland
C14.8 Overlapping lesion of lip, oral cavity and cavity and pharynx
C21.8 Overlapping lesion of rectum, anus and anal canal
C24.8 Overlapping lesion of biliary tract
C26.8 Overlapping lesion of digestive system
C39.8 Overlapping lesion of respiratory and intrahepatic organs
Rule C. Tumors involving more than one
topographic category or subcategory
Site code Description
C41.8 Overlapping lesion of bones , joints, and articular cartilage
C49.8 Overlapping lesion of connective, subcutaneous and other soft
tissue
C57.8 Overlapping lesion of female genital organs
C63.8 Overlapping lesion of male genital organs
C68.8 Overlapping lesion of urinary organs
C72.8 Overlapping lesion of brain and central nervous system
Rule C. Tumors involving more than one
topographic category or subcategory
Adenocarcinoma of antrum and pylorus of stomach C16.8
Carcinoma of tip and ventral surface of tongue C02.8
Carcinoma of esophagus and stomach C16.0 (cardia, EG junction)
Carcinoma of tip of tongue extending to involve
ventral surface C02.1 (tip is the point of origin)
D. Topography codes for lymphoma
1. If the site of origin of the lymphoma is in the lymph nodes
code to C77._
2. If a lymphoma involves multiple lymph node regions code
to C77.8
3. Code extranodal lymphomas to the site of origin
(stomach, intestine, brain)
4. Unknown primary site code to C80.9
Rule E. Topography codes for leukemia
Code all leukemias to C42.1 (bone marrow )
Except myeloid sarcoma ( M-9930/3) use specific site code
Myeloid sarcoma is a leukemic deposit in an organ or tissue
Morphology
Rule F. Behavior Code in
Morphology (The “Matrix Principle”)
Use the appropriate 5th digit behavior code even if the
exact term is not listed in ICD-O.
Behavior
Example: Carcinoma spread to lung and the site of
origin is unknown
The appropriate code is C80.9 (unknown primary site)
M-8010/3 (carcinoma)
Rule G. Grading or differentiation
• Assign the highest grade or differentiation code described
in the diagnostic statement
Tumor grade
Tumor grade
- /X1 Well-differentiated / Low-grade / Grade I
- /X2 Moderately-differentiated / Intermediategrade/ Grade II
- /X3 Poorly-differentiated / High-grade /Grade III
- /X4 Undifferentiated / Anaplastic
- /X5 T cell
- /X6 B cell
- /X7 Null cell / Non T – Non B
- /X8 NK cell
- /X9 Not determined, Not stated or Not applicable
Rule G. Grading and differentiation code
Implied rule: Code to the higher grade
Example: Moderately to poorly differentiated adenocarcinoma of
prostate
◦ Moderately differentiated=grade 2
◦ Poorly differentiated=grade 3
◦ Code diagnosis as 8140/33
Rule G. Grading and differentiation
code
The grading codes can applied to all the malignant neoplasms listed
in ICD-O if the diagnosis includes information about grade or
differentiation.
Example : Anaplastic squamous cell carcinoma
squamous cell carcinoma = 8070/3
anaplastic grade=4
code diagnosis as 8070/34
not correct to code M8070/39 , which not indicate grade
WHO grading system (malignancy scale)
for central nervous system tumors
PAGE 39-40
CNS
In 1993, WHO developed a malignancy scale for CNS tumors WHO
grading is not the same as the ICD-O differentiation and grade code
(6th digit) ICD-O 6th digit grade/differentiation- prefer terms from
diagnosis “low grade or anaplastic”-rather than use the reported
WHO grade.
If no verbal description of the grade, must be coded as 9 for ICD-O
grade or differentiation (not determined, not stated)
Oligoastrocytomas
Low grade (WHO grade II) M9382/31
Anaplastic (WHO grade III) M9382/34
6th digit also used to identify T-cell and B-cell origin for
lymphomas and leukemias
Tumor grade
Rule H. Site associated morphology
term
Some terms for neoplasms imply origin in certain sites or
types of tissue.
Retinoblastoma C69.2 (retina)
Hepatocellular carcinoma C22.0 (liver)
Meningioma C70._ (meninges)
Infiltrating duct carcinoma, NOS C50._(breast)
When a different primary site is given, coder should
ignore the topography code listed in ICD-O and use
the appropriate code
Basal cell carcinoma C44._ (skin)
other primary site
C51._Vulva
C60._ Penis
C63.2 Scrotum
Infiltrating duct carcinoma, NOS C50._(breast)
other primary site
C07.9 Parotid gland
C08._ Salivary gland
C25._ Pancreas
Rule J. Compound morphology
diagnoses
Change the order of the word roots in a compound term if the term is not
listed in ICD-O.
◦ Myxofibrosarcoma (not listed)
◦ Break into word roots
◦ Myxo/ fibro/ sarcoma
Change around word roots, then look up new term
◦ Fibromyxosarcoma M 8811/3
◦ Chondro-osteosarcoma
◦ Osteochondrosarcoma M 9180/3
Rule K: Coding multiple morphology
term
Use the numerically higher number if the diagnosis of a
single tumor includes two modifying adjectives with
different code number.
Transitional cell epidermoid carcinoma
Transitional cell carcinoma M-8120/3
Epidermoid carcinoma M-8070/3
use M-8120/3
Rule K: Coding multiple morphology
term
Look for a code that represents the combined morphology.
Common combinations may have a unique code
 Usually say “mixed” or “combined” or “and”
◦ Ductal carcinoma and lobular carcinoma =8522/3
 Compound terms
◦ Carcinosarcoma =8980/3
Diagnosis:
Poorly differentiated hepatocellular carcinoma of right lobe of liver
Break phrase into topography and morphology
Look up morphology first
Look up unusual term first
Use up all the words in the phrase
Add 5th and 6th digit codes
Look up topography if necessary
Coding example 1
Diagnosis: Poorly differentiated hepatocellular carcinoma of right
lobe of liver
What is it (morphology)?
◦ Hepatocellular carcinoma =8170/3 (C22.0)
What else do we know?
◦ Poorly differentiated = ____/_3
Where did it start (topography)?
◦ Liver, right lobe =C22.0 Liver, NOS
Complete code = C22.0 M8170/33
Coding example 2
Diagnosis: Moderately differentiated adenocarcinoma of prostate
What is it (morphology)?
◦ Adenocarcinoma (not otherwise specified)=8140/3
What else do we know?
◦ Moderately differentiated = ____/_2
Where did it start (topography)?
◦ Prostate =C61.9
Complete code = C61.9 M8140.32
Coding exercise 1
Ductal carcinoma, grade II to III, arising in the upper outer quadrant
of the right breast
Topography Morphology
? ?
What Rule did you use to determine the differentiation code?
Coding exercise 1
Ductal carcinoma, grade II to III, arising in the upper outer quadrant
of the right breast
Topography Morphology
C50.4 8500/33
What Rule did you use to determine the differentiation code?

Rule G : Assign the highest grade code

Coding exercise 2
Nodular melanoma of the leg
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Coding exercise 1
Ductal carcinoma, grade II to III, arising in the upper outer
quadrant of the right breast
Topography Morphology
? ?
What Rule did you use to determine the differentiation
code?
Coding exercise 1
Ductal carcinoma, grade II to III, arising in the upper outer
quadrant of the right breast
Topography Morphology
C50.4 8500/33
What Rule did you use to determine the differentiation
code?
Rule G : Assign the highest grade code
Coding exercise 2
Nodular melanoma of the leg
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Rule A : code the appropriated tissue of origin rather than
NOS
Coding exercise 2
Nodular melanoma of the leg
Topography Morphology
C44.7 8721/39
What Rule did you use to determine the correct primary
site?
Rule A : code the appropriated tissue of origin rather than
NOS
Coding exercise 3
Perigastric carcinoma
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Coding exercise 3
Perigastric carcinoma
Topography Morphology
C76.2 8010/39
(Intra-abdominal site, NOS)
What Rule did you use to determine the correct primary site?
Rule B : code the appropriated ill-defined subcategory C76 when
they not list in ICD-O
Coding exercise 4
Moderately differentiated adenocarcinoma of descending and
sigmoid colon
Topography Morphology
? ?
What Rule did you use to determine the correct primary site?
Coding exercise 4
Moderately differentiated adenocarcinoma of descending and
sigmoid colon
Topography Morphology
C18.8 8140/32
What Rule did you use to determine the correct primary site?
Rule C : Use the “.8” when the tumor overlaps the boundaries of two
categories
Code exercise 5
Mucinous adenocarcinoma in situ of the cecum
Topography Morphology
? ?
What Rule did you use to determine the correct behavior code?
Code exercise 5
Mucinous adenocarcinoma in situ of the cecum
Topography Morphology
C18.0 8480/29
What Rule did you use to determine the correct behavior
code?
Rule F : Use the appropriated 5th digit behavior code
Coding exercise 6
Diffuse large B-cell lymphoma
Topography Morphology
? ?
What Rule did you use to determine the correct primary site?
What Rule did you use to determine the correct
grade/differentiation?
Coding exercise 6
Diffuse large B-cell lymphoma
Topography Morphology
C77.9 9680/36
Lymph node, NOS
What Rule did you use to determine the correct
primary site?
Rule D : Topography code for lymphoma
What Rule did you use to determine the correct grade/differentiation?
Rule G : Use to identify cell type of lymphoma
Coding exercise 7
Ovarian cancer
Topography Morphology
? ?
What Rule did you use to determine the correct morphology code?
Coding exercise 7
Ovarian cancer
Topography Morphology
C56.9 8000/39
What Rule did you use to determine the correct morphology code?
Use Guidelines on page 27
Cancer=malignant neoplasm : M8000
Carcinoma : M8010/39
Coding exercise 8
Wilms’ Tumor
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Coding exercise 8
Wilms’ Tumor
Topography Morphology
C64.9 8960/39
Kidney
What Rule did you use to determine the correct primary
site?
Rule H : Site-associated morphology term
Code exercise 9
Ductal carcinoma in situ of the pancreas
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Coding exercise 9
Ductal carcinoma in situ of the pancreas
Topography Morphology
C25.3 8500/29
What Rule did you use to determine the correct primary
site?
Rule H : Ignore the topography code listed in ICD-O when a
different primary site is given.
Coding exercise 10
Myoleiosarcoma of uterus
Topography Morphology
? ?
What Rule did you use to determine the morphology code?
Coding exercise 10
Myoleiosarcoma of uterus Leiomyosarcoma
Topography Morphology
C55.9 8890/39
What Rule did you use to determine the morphology code?
Rule J : Change the order of word root
Coding exercise 11
Transitional squamous cell carcinoma
Topography Morphology
? ?
What Rule did you use to determine the morphology code?
Coding exercise 11
Transitional squamous cell carcinoma
Topography Morphology
C67.9 8120/39
What Rule did you use to determine the morphology code?
Rule K : Use the highest number
TCC 8120
SCC 8070
Coding exercise 12
Chronic myeloid leukemia
Topography Morphology
? ?
What Rule did you use to determine the correct primary
site?
Coding exercise 12
Chronic myeloid leukemia
Topography Morphology
C42.1 9863/39
(Bone marrow)
What Rule did you use to determine the correct primary
site?
Rule E : Topography code for leukemia
Thank you