# Personal Hx of Cancer ICD-9



## jhuelbig (Aug 31, 2010)

When is the appropriate time to start using the V codes for personal history of cancer?  I work at an Oncology practice and we have many patients with a remote (15 year) history of cancer and we are still coding them as active cancer patients.  We have an audit coming up on ICD-9 codes and I would like to correct this for future coding.  TIA!


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## SCanterbury (Aug 31, 2010)

Per the ICD-9 Official Guidelines for Coding and Reporting found here:

_When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy._


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## jhuelbig (Sep 1, 2010)

Thank you!

One more question: So if a breast cancer is taking oral meds for a 5 year period we could still continue to code 174 because she is still on ongoing treatment, even if there is no evidence of disease?


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## jharrell (Sep 1, 2010)

This is my interpretation of the guidelines.  Because the provider is still treating that site even if it is Prophylactic meds, it is still treatment.  I would like to know what others think?  I am currently having this debt with some co-workers who happen to not be coders but have been doing education for coding.  I can't find any other enough other than the guidelines on this and if anyone does have anything else please post.

Thanks, 
Jessica Harrell, CPC


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## mitchellde (Sep 1, 2010)

The is an old coding clinic that is still relevant for this issue it is M-J 1985, and a lot of questions are answered in it.  But yest as long as you are treating the neoplasm we code it as active, the tamoxifen is a drug that treats cancer so it is not prophlactic it is active cancer treatment.  Look in the PDR for the drug indications if you are ever unsure.


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## jharrell (Sep 1, 2010)

I have looked at that coding clinic and I just can't find anything in it.  But what if they are using the med as a prophlactic treatment after Chemo?  I still think it is active but I just can't convince some others!  I will look again at the 1985 M-J coding clinic. Thanks


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## mitchellde (Sep 1, 2010)

If the treatment is prophylactic  then the patient does not have/has not had  active disease process, therefore you use a V code for prophylactic administration of chemotherapy.  We do this when a patient has a strong family history of the same type of cancer.  So If you are still treating the cancer then there is the probability of active cancer cells but not necessarily obvious so the physician will use a long term treatment.   Got to the PDR and look under the indication for the drug.  It will in all likelihood same cancer not history of cancer.  Maybe that will help?


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## preserene (Sep 2, 2010)

If you would read this brief notes, you would understand the merits of long term oral cancer therapy.
The increasing use of oral agents in breast cancer suggest that many of the concerns and perceptions about oral therapy, including efficacy and bioavailability, have been overcome, and *that oral therapy are/ will play a major role in breast cancer management in the future in both the metastatic and adjuvant settings. *Offering numerous benefits to patients, oncologists, oncology nurses, pharmacists and healthcare providers, the development and refinement of currently available oral treatments for breast cancer and the introduction of new oral agents are likely to overturn previous perceptions of oral chemotherapy. 
One of the reasons  for the necessity for long term oral therapy is to validate its efficacy and bioavailability,especially with metastatic situations, with drug tolerated individuals. Another factor is the merits of oral effective therapy over the illeffects of secondaries with the short or unpredictable survival span. Patients cross the years of survival expectancy to longitivity and this outweighs the fear of illeffects of prolonged therapy. We all know in most cases with metastasis, the survival is limited. Patient compliance will not be an issue with oral cancer therapy, because the seriousness of the disease will provide adequate motivation for adherence to the prescribed regimen.
Oral cyclophosphamide has been an important component of adjuvant therapy for breast cancer for over a decade, permitting self administration in a convenient setting and allowing patients to have a greater role in their therapy. Several all-oral regimens are also under investigation in breast cancer.
Studies of metronomic therapy using an all-oral combination of cyclophosphamide and methotrexate suggest that this is an effective and minimally toxic approach. In a large trial in patients with treated or untreated advanced breast cancer, low-dose oral cyclophosphamide and methotrexate produced responses in 21% of pat some clearly overcome the concerns held by oncologists regarding efficacy and bioavailability (e.g. addition of capecitabine to docetaxel improves survival in metastatic breast cancer) and have the potential to offer patients improved convenience and home-based therapy in studies patients median overall survival of 18.2 months [Objective response correlated with prolonged clinical benefit.
 In the adjuvant setting, depending on the adverse-event profile, oral therapy enables patients to return to normal as soon as possible or permits different approaches to therapy (shortening intensive therapy and allowing maintenance therapy.
However, who could vouch for sure, the cancer(cell) free metastatic sites within stipulated time/or till the end of time?; 
in blood cancer oral mercaptopurine is a successful therapy, though.

As Mitchellede puts it in a nut shell, patient is on treatment and it is still on its way, and I feel that yet time to go to the reach of,  "Personal history of".
Thank you for your time.


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## jhuelbig (Sep 2, 2010)

Thanks for all the responses.  Another related question:  We use Zometa for treatment induced osteopenia and osteoporosis, some of these patients have been disease free for years.  We code it with breast CA as the primary dx, is this appropriate if the patient is not on any other therapy?  Our pharmacist believes it is appropriate to use the cancer dx as primary because the ailment was sustained as a result of the treatment, even if there no evidence of disease.  Does anyone have any thoughts on this situation if the patient is not on any other treatment, oral or otherwise? TIA


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## mitchellde (Sep 2, 2010)

Zometa does not treat breast ca it treats osteopenia or osteoporosis.  If the osteo.. condition is due to the cancer treatment then you use the osteo code first followed by an adverse effect E code and a hx of Breast cancer code if there is no evidence of disease and no futher tx.


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