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ICD-10 Guide
ICD-10 CodesC78.02

C78.02

Billable

Secondary malignant neoplasm of left lung

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 C78.02 is a billable code used to indicate a diagnosis of secondary malignant neoplasm of left lung.

Key Diagnostic Point:

C78.02 refers to a secondary malignant neoplasm located in the left lung, indicating that the cancer has metastasized from a primary site elsewhere in the body. This condition is characterized by the presence of malignant cells in the lung tissue that originated from a different primary cancer, which may be unknown at the time of diagnosis. The left lung is specifically affected, which can have implications for treatment and prognosis. Metastatic lung cancer often presents with symptoms such as cough, chest pain, and difficulty breathing. Diagnosis typically involves imaging studies such as CT scans and may require biopsy for confirmation. Staging of the disease is crucial, as it helps determine the extent of the metastasis and guides treatment options. Palliative care considerations are essential for managing symptoms and improving the quality of life for patients, especially when the primary cancer is advanced or when curative treatment is not feasible. The management of secondary malignant neoplasms often involves a multidisciplinary approach, including oncologists, pulmonologists, and palliative care specialists.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Determining the primary site of cancer can be challenging.
  • Need for accurate staging to guide treatment.
  • Potential for multiple metastatic sites complicating coding.
  • Documentation must clearly indicate the secondary nature of the neoplasm.

Audit Risk Factors

  • Inadequate documentation of the primary cancer site.
  • Failure to document staging information.
  • Misclassification of primary versus secondary neoplasms.
  • Lack of clarity in the treatment plan related to metastatic disease.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the primary cancer, staging information, and treatment plans.

Common Clinical Scenarios

Patients presenting with symptoms of lung involvement after a known primary cancer diagnosis.

Billing Considerations

Ensure clear documentation of the metastatic nature and any treatments administered.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging results, and symptom assessments.

Common Clinical Scenarios

Patients with respiratory symptoms and a history of cancer.

Billing Considerations

Document the impact of lung involvement on respiratory function and quality of life.

Coding Guidelines

Inclusion Criteria

Use C78.02 When
  • According to ICD
  • 10 coding guidelines, C78
  • 02 should be used when there is clear documentation of a secondary malignant neoplasm in the left lung
  • It is important to ensure that the primary site is documented, even if it is unknown
  • The code should not be used for primary lung cancers or benign neoplasms

Exclusion Criteria

Do NOT use C78.02 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

32405CPT Code

Video-assisted thoracoscopic surgery (VATS) for lung biopsy

Clinical Scenario

Used when a biopsy is needed to confirm metastatic disease in the left lung.

Documentation Requirements

Document indications for biopsy, imaging results, and patient consent.

Specialty Considerations

Oncologists and pulmonologists should collaborate on the procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of secondary malignancies, improving the accuracy of cancer registries and treatment planning. C78.02 provides a clear distinction for coders to identify metastatic disease in the left lung, which is crucial for patient management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of secondary malignancies, improving the accuracy of cancer registries and treatment planning. C78.02 provides a clear distinction for coders to identify metastatic disease in the left lung, which is crucial for patient management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of coding C78.02?

Coding C78.02 is significant as it indicates the presence of metastatic disease in the left lung, which has implications for treatment, prognosis, and resource allocation in patient care.