Don’t use the Neoplasm Table with Neuroendocrine Tumors (NET)

Previously neuroendocrine tumors (NETs) were called carcinoid tumors and some clinicians will continue to call them carcinoid tumors.  This is a physician query opportunity.

They are not universally consistent in their characteristics. Some neuroendocrine cancer grows quickly while others grow slowly. Most of these tumors develop in the lungs, appendix, small intestine, rectum, testicles, ovaries, and pancreas, but and essentially, can be found anywhere. Some tumors can produce hormones, while others don’t.  Symptoms may vary depending on the part of the body affected by the tumor.[i] They are comprised of cells that may produce hormonal syndromes which impact the normal hormonal balance that supports body system functions.

NETs can be malignant or benign.  Unfortunately, the clinical documentation we see as coders, does not always clearly specify malignant or benign.  So, here’s another physician query opportunity!  If the documentation does not specify the NET as malignant or benign, the default is benign.  This path to benign is per the indexing of tumor, neuroendocrine:  D3A.8-Other benign carcinoid tumors

Often this neuroendocrine tumor is abbreviated in the documentation.  Look for NET or other abbreviations such as PNET or PanNET for pancreatic NET, GINET for gastrointestinal NET, and WDNET or PD NET for well-differentiated or poorly-differentiated neuroendocrine tumor.

IMPORTANT:  Neuroendocrine tumors have their own set of codes. They are not coded from the neoplasm table codes. I can’t explain the logic for not including them in the table!

• Category D3A.00-D3A.8 are Benign carcinoid tumors of specific sites and includes a code for unspecified site
• Category C7A.00-C7A.098-Malignant Carcinoids by site
• Category C7B.00-C7B.09-Secondary Carcinoid Tumors by site
• Category C7A.1-Malignant poorly differentiated neuroendocrine tumors (Any Primary site); Includes High Grade
• Category C7A.8-Other malignant neuroendocrine tumors (Any Primary site)
• Category C7B.1-Secondary Merkel cell carcinoma (NOTE: Do not use secondary codes from the neoplasm table) Primary Merkel cell is category C4A
• Category C7B.8-Other secondary neuroendocrine tumors. (NOTE:  Do not use secondary codes from the neoplasm table)

These tumors arise from epithelium; thus, malignant tumors in this group are referred to as neuroendocrine carcinomas.[ii]  NETs can spread to the bones, brain, lungs, and other locations. The type and location of the cancer influences the treatments.  Treatment may include surgery, radiation, targeted therapy, or a combination of these treatment techniques. Finally, many of the tumors in the categories above yield an HCC and some a RxHCC.

If you remember one thing about NETs, it’s to NOT use the neoplasm table.  Coders and clinical documentation integrity specialists play a vital role in accurately capture the documentation needed to apply a specific code for NETs and help future clinicians prepare an appropriate care plan for the patient.

About the Author:  Pam Scott is Vice President of Coding Support and Compliance Services at St. Louis-based First Class Solutions, Inc.  She is the firm’s educator, a frequent speaker at State HIM meetings, and serves as a coding compliance auditor for several of the firm’s clients.

https://www.sayyestohope.org/neuroendocrin/#:~:text=In%20the%20later%20stages%20of,%2C%20difficulty%20breathing%2C%20and%20diarrhea.

https://librepathology.org/wiki/Neuroendocrine_neoplasms