Q&A: Sequencing metastasized lung cancer
CRC, answered this question.
Q: We recently had a patient come in with bilateral shoulder pain and numbness. The patient also had lung cancer, metastasized to spine. What should we sequence as the principal diagnosis? The patient is currently undergoing chemo therapy.
A: The selection of the principal diagnosis in a case of a patient with lung cancer that has spread to the spine depend on the reason for the admission. The Uniform Hospital Discharge Data Set (UHDDS) definition of a principle diagnosis applies here.
If the patient is admitted primarily to address the lung cancer, then lung cancer could be the principal diagnosis. If the patient is admitted primarily to address the spinal cancer, then the spinal cancer may be the principal diagnosis. If the patient is being admitted not to address either cancer surgically or diagnostically but rather to administer chemotherapy, then the principle diagnosis is admission for chemotherapy administration, which is a Z-code. If the patient came in for pain control, the principle diagnosis could be “neoplasm related pain,” particularly if only pain control was delivered, and the cancer was not specifically addressed during the stay.
Without more information, I’d have to wager a guess, and would think that the principal diagnosis would either be neoplasm related pain or the spinal cancer as the principle diagnosis—if the spinal cancer was either a new diagnosis identified for the first time or if the spinal cancer was biopsied or surgically addressed during the encounter.
For more information, see the Official Guidelines for Coding and Reporting, p. 29, related to sequencing neoplasms.
Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for HCPro in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps, click here.