How to Code Lung Cancer & Drain Care in ICD-10
The patient is being admitted to home health following surgery for left lower lobe lung cancer and will need dressing changes, care for his surgical drain, and teaching on newly prescribed oxygen use. His physician plans to begin chemo immediately.
M1021a – Z48.3 Aftercare following surgery for neoplasm
M1023b – C34.32 Malignant neoplasm of lower lobe, left lung
M1023c – Z48.03 Encounter for change or removal of surgical drain
M1023d – Z48.01 Encounter for change or removal of surgical dressing
M1023e – Z99.81 Dependence on supplemental oxygen
Because the primary focus of care by the home health agency is the patient’s recent surgery, this is coded first. The cancer is considered still present as treatment via chemo is continuing, so the specific neoplasm code is used next. If physician documentation would have indicated that the surgery eradicated the cancer and no longer required treatment, a history code would have been used instead. Lastly the codes for drain care, dressing care, and oxygen use follow.