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Coding Roundtable

Carcinoid Tumor Discussion from Coding Roundtable 4/2009 

For FY 2008, a series of diagnostic codes were created at subcategory 209, Neuroendocrine Tumors. An instructional note under this subcategory stated that coders were to "Code first any associated multiple endocrine neoplasia syndrome (258.01-258.03)". Medicare contractors had interpreted this note to mean that none of the codes in subcategory 209 were acceptable principal diagnoses and had entered these codes on the MCE edit for unacceptable principal diagnoses. We later deemed this interpretation to be incorrect. We had not intended that the series of codes at subcategory 209 were only acceptable as secondary diagnoses.  To avoid future misinterpretation, in this proposed rule, we are proposing to remove the following codes from the MCE edit for unacceptable principal diagnoses. 

209.00 (Malignant carcinoid tumor of the small intestine, unspecified portion)

209.01 (Malignant carcinoid tumor of the duodenum)

209.02 (Malignant carcinoid tumor of the jejunum)

209.03 (Malignant carcinoid tumor of the ileum)

209.10 (Malignant carcinoid tumor of the large intestine, unspecified portion)

209.11 (Malignant carcinoid tumor of the appendix)

209.12 (Malignant carcinoid tumor of the cecum)

209.13 (Malignant carcinoid tumor of the ascending colon)

209.14 (Malignant carcinoid tumor of the transverse colon)

209.15 (Malignant carcinoid tumor of the descending colon)

209.16 (Malignant carcinoid tumor of the sigmoid colon)

209.17 (Malignant carcinoid tumor of the rectum)

209.20 (Malignant carcinoid tumor of unknown primary site)

209.21 (Malignant carcinoid tumor of the bronchus and lung)

209.22 (Malignant carcinoid tumor of the thymus)

209.23 (Malignant carcinoid tumor of the stomach)

209.24 (Malignant carcinoid tumor of the kidney)

209.25 (Malignant carcinoid tumor of foregut, not otherwise specified)

209.26 (Malignant carcinoid tumor of midgut, not otherwise specified)

209.27 (Malignant carcinoid tumor of hindgut, not otherwise specified)

209.29 (Malignant carcinoid tumor of other sites)

209.30 (Malignant poorly differentiated neuroendocrine carcinoma, any site)

209.40 (Benign carcinoid tumor of the small intestine, unspecified portion)

209.41 (Benign carcinoid tumor of the duodenum)

209.42 (Benign carcinoid tumor of the jejunum)

209.43 (Benign carcinoid tumor of the ileum)

209.50 (Benign carcinoid tumor of the large intestine, unspecified portion)

209.51 (Benign carcinoid tumor of the appendix)

209.52 (Benign carcinoid tumor of the cecum)

209.53 (Benign carcinoid tumor of the ascending colon)

209.54 (Benign carcinoid tumor of the transverse colon)

209.55 (Benign carcinoid tumor of the descending colon)

209.56 (Benign carcinoid tumor of the sigmoid colon)

209.57 (Benign carcinoid tumor of the rectum)

209.60 (Benign carcinoid tumor of unknown primary site)

209.61 (Benign carcinoid tumor of the bronchus and lung)

209.62 (Benign carcinoid tumor of the thymus)

209.63 (Benign carcinoid tumor of the stomach)

209.64 (Benign carcinoid tumor of the kidney)

209.65 (Benign carcinoid tumor of foregut, not otherwise specified)

209.66 (Benign carcinoid tumor of midgut, not otherwise specified)

209.67 (Benign carcinoid tumor of hindgut, not otherwise specified)

209.69 (Benign carcinoid tumor of other sites)

 In the meantime, CMS has issued instructions in the form of an interim working document called a joint signature memorandum to the Medicare contractors to override this edit and process claims containing codes from the subcategory 209 series as acceptable principal diagnoses.