Q&A: ICD-10 coding for malignant neoplasms

Q: A 64-year-old female inpatient has hepatocellular cancer with an orthotropic liver transplant with bile duct obstruction and is immunosuppressed due to drugs. Which ICD-10-CM codes would be reported?

A: The scenario would be reported with ICD-10-CM codes as follows:

• Primary diagnosis: T86.49, other complications of liver transplant
• MCC: K83.1, obstruction of bile duct
• CC:
  
  • D84.821, immunodeficiency with drugs
  • C80.2, malignant neoplasm associated with transplanted organ
  • C22.0, hepatocellular cancer

Going to the 2024 ICD-10-CM Official Guidelines for Coding and Reporting, there's a section in Chapter 2 (Neoplasms), section r. “Malignant neoplasm associated with transplanted organ”:

A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign first the appropriate code from category T86.-, Complications of transplanted organs and tissue, followed by code C80.2, Malignant neoplasm associated with transplanted organ. Use an additional code for the specific malignancy.

So, the coder would report at least three codes.

In my old way of thinking, before I found these rules, I would have put the cancer code first. But that's not the correct way to do it. We would put this other complication first (T86.49), then the malignancy of the transplanted organ (C80.2), then the type of cancer (C22.0). This particular case with obstruction of the bile duct would act as an MCC for the MS-DRG. The MS-DRG would be 441 (with MCC).

Editor’s note: Penny Cassady, RN, CCDS, a CDI auditor and educator based in Houston, Texas, answered this question during the HCPro webinar “It's Complicated: Capturing Transplant Complication Codes.” This answer was originally published in JustCoding.