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!
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://librepathology.org/wiki/Neuroendocrine_neoplasms
This week Blue Cross Blue Shield published an article titled “Study suggests AI is boosting hospital billing.” The study was based on data analyzed by
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
