# Cancer Coding



## mattstella101 (Aug 18, 2011)

A lot of our physicians will mention a certain type of cancer (without using the word history) and document that the patient is just following up with oncology. They seem to be using current cancer codes because they do not realize that history codes exist. Is it okay to use current (cancer) codes based on that documentation even though when I look at surgery and oncology notes I see that it has been removed and chemo was done? I know I shouldn't be coding based on other clinics but for the most part the physicians rarely use the word "history." Please help thanks!


----------



## JoyceC (Aug 18, 2011)

*Same issue*

I have the exact same problem in our practice. Looking forward to a definitive answer.


----------



## mattstella101 (Aug 18, 2011)

*also...*

I don't want to assume that it's history, and our physicians do it so much that it would be really time consuming to contact every single one and verify. Not sure if there are definitive guidelines regarding this.


----------



## ppreston (Aug 18, 2011)

*Cancer hx & follow ups*

I have this problem with my docs ,also. Coding rules state that if no treatment is being provided for the cancer & it has been excised or otherwise eradicated, Hx of codes are what should be used. MDs have a hard time understanding that this impacts a patient's ability to get insurance. I have finally gotten most of them to realize that if the dictation states Hx of or my all time favorate NED (no evidence of disease) that the code needs to be a v code. I also use V67.2 (chemo follow up) This should only be used if pt is not currently getting chemo. Hope this helps some.


----------



## armen (Aug 18, 2011)

mattstella101 said:


> A lot of our physicians will mention a certain type of cancer (without using the word history) and document that the patient is just following up with oncology. They seem to be using current cancer codes because they do not realize that history codes exist. Is it okay to use current (cancer) codes based on that documentation even though when I look at surgery and oncology notes I see that it has been removed and chemo was done? I know I shouldn't be coding based on other clinics but for the most part the physicians rarely use the word "history." Please help thanks!



From ICD 9 official guidlines:

If the treatment is directed at the malignancy, designate the malignancy as the principal diagnosis.
The only exception to this guideline is if a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign the appropriate V58.x code as the first-listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis.

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. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code


----------



## jgf-CPC (Aug 18, 2011)

Excellent info Armen...I was looking for the guidelines and saw you had just put it here. Thanks!


----------



## j.berkshire (Aug 19, 2011)

I'd like to piggy-back on this thread and ask if your claims are being paid when you use the history-of "V" code for these cancer followup visits.  

Any thoughts or comments?


----------



## jgf-CPC (Aug 19, 2011)

Mine is normally the secondary code so can't really answer that.


----------



## akonyk (Jul 10, 2012)

*Payment for V-codes after cancer trtmt*

I would like more info on the reimbursement of the V-codes for history of cancer patients.

Is there anyone that can clarify what the best way to code these visits and still retain reimbursements?

I'm told that Medicare will not pay for any of the V-codes. If anyone has more info, please email me direct to akonyk@gmail.com..

Thanks


----------

