Q&A: Coding neoplasms in transplanted organs

Q: Which codes are required for properly reporting neoplasms in transplanted organs?

A: While there are very specific guidelines in ICD-10-CM for transplantations procedures, there are special guidelines for neoplasms in transplanted organs. In general, three codes should be reported:

• A code from category T86.-, Complications of transplanted organs and tissue
• Code C80.2, Malignant neoplasm associated with transplanted organ
• A code for the specific site of the malignancy for the organ involved

The second and third codes aspecify the complication further because the code from category T86.- lacks the necessary specificity to describe the neoplastic complication. If coders find the main term “complication” followed by “transplant” in the 2025 ICD-10-CM Alphabetic Index, they will be able to find two of the three codes.

Consider an example where a patient had hepatocellular cancer and received a liver transplant. They now present with a liver cell carcinoma. This simple case requires three codes, the first of which is T86.49, Other complications of liver transplant). For this scenario, if coders find the main term “complication” followed by “transplant” in the index, they will be referred to category T86.- and will need to find the appropriate subterm based on the affected organ (i.e. “liver”). All codes in this category have a note to use additional codes that identify other transplant complications including malignancy associated with an organ transplant (C80.2), which is the second code required.

Another way to find this code is by looking up the main term “complication” followed by “transplant” and “malignant neoplasm” in the index. Code C80.2 has a note to use an additional code as well to identify the specific malignancy. The main term “carcinoma” and subterm “liver cell” lead to the correct and final code C22.0, Liver cell carcinoma.

Typically, coders should not assume dysfunction of a transplanted organ to be a complication of the transplantation unless documentation has clearly indicated that the condition is a complication of surgery. The only exception to this is when there is a malignant neoplasm of a transplanted organ. A neoplasm associated with a transplant is coded as an "other complication of transplant" unless specified by the provider as a failure or rejection. When in doubt, query the provider.

As a reminder, here are some general guidelines for coding surgical complications:

• There is no time limit on coding a complication
• Complications following surgery or medical care should always be coded
• When admission is for treatment of a complication resulting from medical care, list the complication code first
• Complication does not mean poor care or improper care has been delivered

Editor’s note: This question was answered by Terry Tropin, MSHAI, RHIA, CCS-P, an AHIMA-approved ICD-10-CM/PCS trainer who taught medical terminology and medical coding at Montgomery College in Maryland for more than two decades, during the HCPro webinar, “ICD-10-CM Coding for Surgical Complications.” This article was originally published in JustCoding.