This document provides information about ICD coding for common cancers. It discusses: - The International Classification of Diseases (ICD), which is used to code and classify diseases and health problems. The current version is ICD-10. - ICD-10 codes are used to classify neoplasms (tumors) by location and behavior in Chapter II. Common cancer locations are coded individually. - In addition to location, cancers are classified by morphology (histology/appearance) and behavior (benign, malignant, etc). - The International Classification of Diseases for Oncology (ICD-O) incorporates ICD site codes and standardized morphology codes to fully classify cancers. - ICD

1. ICD CODING FOR COMMON
CANCERS
DR. DEBARSHI LAHIRI, M.D.
KOLKATA, INDIA

2. ICD
INTERNATIONAL CLASSIFICATION OF DISEASES
(and related health problems) published by the
WHO (the 10th revision of which (WHO, 1992) is in
current use)
It is used to code and classify diseases and other
health problems recorded on many types of health
and vital records including death certificates.
Designed to promote international comparability in
the collection, processing, classification, and
presentation of morbidity and mortality statistics.

3. ICD-10
Translates diagnoses of diseases and other health problems
from words into an alphanumeric code, which permits easy
storage, retrieval and analysis of the data.
(Till ICD-9 , Numeric coding system was followed)
(ICD-10 is an Alpha numeric coding system)

4. 22 Chapters
Chapter II – Deals with Neoplasms
C00 to D48
C00-C14: Malignant neoplasms of Lip, Oral Cavity &
Pharynx
C15-C26: Malignant Neoplasms of Digestive Organs
C30-C39: Malignant Neoplasms of Respiratory
System & Intrathoracic Organs
C40-41: Malignant Neoplasms of Bone & Articular
Cartilage

5. C43-C44: Skin
C45-C49: Connective & Soft Tissue
C50-C58: Breast & Female Genital Organs
C60-C63: Male Genital Organs
C64-68: Urinary Organs
C69-C72: Eye, Brain & CNS
C73-75: Endocrine glands & related structures
C76-80: Secondary & ill defined
C81-96: Lymphoid & Hemaetopoietic
C97: Independent (primary) Multiple Sites

6. In situ & Benign Neoplasm
D00-D09: In-situ Neoplasm
D10-D36: Benign Neoplasms
D37-D48: Uncertain or Unknown Behaviour

7. Classification of Neoplasms
Two most important items of information:
LOCATION OF THE TUMOUR IN THE BODY:
Synonyms- Anatomical Location/Site/Topography
MORPHOLOGY: Appearance of the tumour when
examined under the microscope (synonyms-
Histology/Cytology)- Indicates its Behaviour
( Malignant/Benign/in situ/uncertain).

8. ICD Classification- Describes only
Topography and Behaviour
MORPHOLOGY ??
CARCINOMA LUNG NOS: C34.9 doesn't
distinguish between NSCLC
(adeno/Squamous)/SCLC/other morphology
Benign Neoplasm: D14.3
In situ: D02.2

9. Cancer Registries were coding for
Morphology even before ICD-O came
1951- 1st coding manual for Morphology developed by
American Cancer Society ( MOTNAC)- Manual of Tumour
Nomenclature & Coding (Cancer Registries at that time
used malignant neoplasm section of ICD-6 for coding
Topography and MOTNAC for Morphology)
WHO-1956- published Statistical Code for Human Tumors
(based on Topography code based on ICD-7 and
Morphology, including behaviour code of MOTNAC)
CAP in 1965 published SNOP (systematized nomenclature
of Pathology)

10. 1968- ACS Revised MOTNAC-Topography
based on ICD-8, Morphology code taken from
SNOP
1976-WHO and IARC collaborated- The
worldwide need for a logical, coherent and
detailed classification for neoplasms was
recognised- Developed the International
Classification of Diseases for Oncology
(ICD-O).-Topography based on ICD-9 and
Morphology on MOTNAC- which was further
modified.
1977-CAP revised SNOP to SNOMED
Incorporated the ICD-O morphology section.

12. What is ICD-O?
Not a true classification system:
Includes codes from multiple classification
Systems.
Actually a coded nomenclature for :
Topography (primary site of origin)
Morphology (histology, behavior, grade)

13. Rationale for ICD-O
To Standardize Cancer Data Collection
To Compare Data:
Regional
National
International

14. ICD O3 TOPOGRAPHY
3rd Edition of ICD-O, Published in Year 2000
TOPOGRAPHY- ICD 10 Classification codes of
Malignant Neoplasms applied for all types of
tumours(whether malignant/Benign/In
situ/uncertain)
Four digit code: C_ _._ ; 3 Digits for the Primary site
followed by Sub-site after a Point.
RANGE: C00.0 – C80.9

15. Topography Code, Examples
LIP:
C00.0: External Upper Lip
C00.1: External Lower Lip
C00.2: External Lip, NOS
C00.3: Mucosa of the Upper Lip
C00.4: Mucosa of the Lower Lip
C00.5: Mucosa of the Lip, NOS

16. LUNG: C34.0: Main Bronchus
C34.1: Upper Lobe
C34.2: Middle Lobe
C34.3: Lower Lobe
C34.8: Overlapping Lesion
C34.9: Lung NOS

17. Lymphoma Arising from the Nodes:
C77.0: Head/Face/Neck
C77.1: Intrathoracic
C77.2:Intrabdominal
C77.3: Axilla or Arm
C77.4: Inguinal/Leg
C77.5: Pelvic
C77.8: Multiple Regions
C77.9:L.N. NOS

18. If a tumor is metastatic and the primary site is
unknown, code primary site to C80.9
All leukemias have a site-specific code of bone
marrow (C42.1) except:
Myeloid sarcoma (rare) – leukemic deposit in an organ
and should be coded to that organ
Multiple myeloma – code site to C42.1

19. Morphology
ICD-O morphology describes histology and
behavior as separate variables, recognizing that
there are a large number of possible
combinations.
In ICD-O, morphology is a 4-digit number
ranging from 8000 to 9989, and behavior is a
single digit which can be 0, 1, 2, 3, 6 or 9.

20. Morphology - Behavior
Behavior is the fifth digit (after the “/”) of the
morphology code
Behavior code indicates the pathologic behavior
of the neoplasm - benign, in situ, malignant
Most registries in the world only collect cancer
with behavior codes 2 (in situ) and 3
(malignant)

21. Morphology:
__ __ __ __ / __ _

23. Morphology – Grade/Differentiation
Grade/Differentiation is the sixth digit (after the /) of
the morphology code
Describes how much or how little a tumor resembles
the normal tissue from which it arose
If a pathology report gives more than one grade/diff,
code to the highest grade/diff

25. 6 Digit Code for Leukemia/Lymphoma
th
5- T Cell
6- B Cell, Pre-B, B- Precursor
7- Null cell Non T- Non B
8- N K Cell (natural Killer)
9- Cell type not determined, not stated, or not
applicable

26. Morphology Codes
Neoplasm, Malignant: M-8000/3
Carcinoma, NOS: M-8010/3
Small cell carcinoma, NOS: M-8041/3
Non small cell carcinoma: M-8046/3
Squamous cll carcinoma, NOS: M-8070/3
Adenocarcinoma, NOS: M-8140/3
IDC, NOS: M-8500/3
Hepatocellular Carcinoma, NOS: M-8170/3

27. ICD-O-3 Code = 10 Digit
Code
TOPOGRAPHY 4 Digits
+
MORPHOLOGY 4 Digits
+
BEHAVIOR 1 Digit
+
GRADE 1 Digit

28. Coding Exercises
Example:
Well Differentiated Invasive Squamous Cell
Carcinoma Hard Palate
Hard Palate: C05.0
Invasive Squamous Cell Carcinoma,NOS: M-8070/3
Well Differentiated: 1
ICD Coding: C05.0M-8070/31

29. Coding Exercise 1.
Moderately Differentiated Invasive
Squamous Cell carcinoma Lateral
Border of tongue Lt.

30. Topography: Lateral Border of Tongue:
C02.1
Morpholgy & Behaviour: Invasive squamous cell
carcinoma
M-8070/3
Grade: Moderately Differentiated
2

31. Answer 1
C02.1M-8070/32

32. Coding Exercise 2
Well Differentiated Adenocarcinoma
Lower Lobe of Lung Lt.

33. Answer 2
C34.3M-8140/31

34. Coding Exercise 3
Infiltrating Duct Carcinoma NOS Grade
III Rt. Breast Upper Outer Quadrant

35. Answer 3
C50.4M-8500/33

36. Coding Exercise 4
Well Differentiated Invasive Squamous
Cell Carcinoma Cervix

37. Answer 4
C53.9M-8070/31

38. ICD-O-3 Training
ICD-O-3 Training Web Site
www.training.seer.cancer.gov
ICD O 3 (3 Edition),
rd
WHO Publication

39. THANK
YOU