Caracterización de las Necesidades Educativas Diversas Como Categorías

When dealing with multiple sites, only sites in Part I of the certificate should be considered.

If malignant neoplasms of more than one site are entered on the certificate, the site listed as primary or not indicated whether primary or secondary should be selected (see D, E and F above).

Multiple sites with none specified as primary

(a) Notwithstanding the provisions of Rule H to consider only sites in Part I, if one of the common sites of metastases, excluding lung, and another site or morphological type are mentioned anywhere on the certificate, code to the other site. If, however, a malignant neoplasm of lymphatic, haematopoietic, or related tissue appears in Part II, only Part I should be considered.

Example 36: I (a) Cancer of stomach (b) Cancer of liver

Code to malignant neoplasm of stomach (C16.9). Although the sequence suggests that the liver was the primary site, metastasis from liver - a common site of metastases - to stomach is improbable and it is assumed that the stomach cancer metastasized to the liver.

Example 37: I (a) Peritoneal cancer II Mammary carcinoma

Code to malignant neoplasm of breast (C50.9), since the peritoneal cancer is presumed secondary because it is on the list of common sites of metastases. (b) Malignant neoplasms described as one site “or” another, or if “or” is implied, should be coded

to the category that embraces both sites. If no appropriate category exists, code to the unspecified site of the morphological type involved. This rule applies to all sites whether they are on the list of common sites of metastases or not.

Example 38: I (a) Carcinoma of ascending or descending colon

Code to malignant neoplasm of colon, unspecified (C18.9).

Example 39: I (a) Osteosarcoma of lumbar vertebrae or sacrum

(c) If two or more morphological types of malignant neoplasm occur in lymphoid, haematopoietic or related tissue (C81-C96), code according to the sequence given since these neoplasms sometimes terminate as another entity within C81-C96. Acute exacerbation of, or blastic crisis in, chronic leukaemia should be coded to the chronic form.

Example 40: I (a) Acute lymphocytic leukaemia (b) Non-Hodgkin’s lymphoma

Code to non-Hodgkin’s lymphoma (C85.9).

Example 41: I (a) Acute and chronic lymphocytic leukaemia Code to chronic lymphocytic leukaemia (C91.1).

Multiple sites in the same organ system

If the sites mentioned are in the same organ system and are contiguous, the .8 subcategories, including those listed in Volume 1, should be used. This applies when the certificate describes the sites as one site “and” another or if the sites are mentioned on separate lines. Code to the .8 subcategory that embraces both sites. If there is any doubt about the contiguity of the sites mentioned, code to the unspecified site of the organ mentioned.

(a) If there is mention of two contiguous subsites in the same site, code to the .8 subcategory of that three-character category.

Example 42: I (a) Carcinoma of descending colon and sigmoid

Code to overlapping malignant neoplasm of colon (C18.8).

(b) If the subsites are not contiguous, code to the .9 subcategory of that three-character category.

Example 43: I (a) Carcinoma of head of pancreas (b) Carcinoma of tail of pancreas

Code to malignant neoplasm of pancreas, unspecified (C25.9).

(c) If there is mention of two contiguous sites classified to separate three-character categories within the same body system, code to the .8 subcategory of that general body system (see list in Note 5 in the introduction to Chapter II of Volume 1).

Example 44: I (a) Carcinoma of vagina and cervix

Code to malignant neoplasm of overlapping sites of female genital organs (C57.8).

(d) If two sites are mentioned on the certificate and both are in the same organ system and have the same morphological type, code to the .9 subcategory of that organ system, as in the following list:

C26.9 Ill-defined sites within the digestive system C39.9 Ill-defined sites within the respiratory system C41.9 Bone and articular cartilage, unspecified C49.9 Connective and soft tissue, unspecified C57.9 Female genital organ, unspecifie C63.9 Male genital organ, unspecified C68.9 Urinary organ, unspecified

C72.9 Central nervous system, unspecified

Example 45: I (a) Pulmonary embolism (b) Cancer of stomach (c) Cancer of gallbladder

(e) If there is no available .8 or .9 subcategory, code to malignant neoplasms of independent (primary) multiple sites (C97).

Example 46: I (a) Cardiac arrest

(b) Carcinoma of prostate and bladder

Code to malignant neoplasms of independent (primary) multiple sites (C97), since there is no available .8 subcategory.

I. Infectious diseases and malignant neoplasms

(a) Owing to the effect of chemotherapy on the immune system, some cancer patients become prone to infectious diseases and die of them. Therefore, any infectious disease classified to A00-B19 or B25-B64 reported as “due to” cancer will be an acceptable sequence whether in Part I or II.

Example 47: I (a) Zoster

(b) Chronic lymphocytic leukaemia

Code to chronic lymphocytic leukaemia (C91.1).

(b) Except for human immunodeficiency virus [HIV] disease, no infectious or parasitic disease will be accepted as causing a malignant neoplasm.

Example 48: I (a) Hepatocellular carcinoma (b) Hepatitis B virus

Code to hepatocellular carcinoma (C22.0).

Example 49: I (a) Burkitt’s tumour (b) Epstein-Barr virus

Code to Burkitt’s tumour (C83.7).

Example 50: I (a) Cholangiocarcinoma of liver (b) Clonorchiasis