# History Of code versus primary code



## bvilla7@brighthouse.com (Feb 27, 2015)

My question is regarding the use of V history of codes versus the primary code. A patient is diagnosed with stage IV kidney cancer.  It is metastatic to the chest wall.  The patient had a nephrectomy but is still receiving treatment (Chemo) because of the mets to chest wall.  Am I going to use the V code for the kidney and the secondary code for the chest wall?  Or should I use the primary kidney code and the secondary code for chest wall?  The reason I am a bit confused is because if a patient is diagnosed with breast cancer and has a mastectomy but still requires radiation or chemo, I would use the primary breast code not the v code but the breast was removed like the kidney above.  Any feedback would be great.


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## mitchellde (Feb 27, 2015)

The reason the primary breast code is still being used in your example is because the primary site is still being treated.  If the kidney as the primary site is still being treated or if documentation supports treatment is still directed at the kidney site ( even if not at this encounter) then the kidney site is still code as primary site.  You sequence first listed the one being treated at this encounter.  If the kidney site requires no further treatment and has no more disease at the kidney site, then the kidney site is coded as history and the metastatic site will be sequenced first listed.  If a metastatic site requires no further treatment and no longer has evidence of disease then you no longer code it.  You do not code history codes for the secondary site.


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## bvilla7@brighthouse.com (Feb 28, 2015)

Thank Debra.  I totally agree but I am being questioned at work.  I guess they are confused because the kidney was removed and I coded it as history of because there is no treatment to the kidney site but there is treatment to the metastatic sites.  But where they are getting confused is why is breast cancer being coded with the primary breast code if the patient had a mastectomy and still requires treatment, how is it directed to the breast site if it was removed?


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## BenCrocker (Feb 28, 2015)

Because it's still focusing on the "breasts" original location. And not anywhere else.


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## mitchellde (Feb 28, 2015)

blanca1402@att.net said:


> Thank Debra.  I totally agree but I am being questioned at work.  I guess they are confused because the kidney was removed and I coded it as history of because there is no treatment to the kidney site but there is treatment to the metastatic sites.  But where they are getting confused is why is breast cancer being coded with the primary breast code if the patient had a mastectomy and still requires treatment, how is it directed to the breast site if it was removed?



The breast site is being still treated with radiation and or chemo so the cancer is still considered current at the primary site.  What I am hearing from you is that the kidney was removed and there is no more treatment being render to the site around where the excision was performed.  That is what will make the kidney as history.  However the kidney cancer has moved on to reside in a secondary location so the cancer at the primary site is history with an active secondary.  If the breast site is no longer being treated but the secondary location is now being treated then it would be the same thing the breast site will be history with active secondary .  Your coworkers are not comparing apples to apples on this.
The breast site is being still treated because removal of the breast unfortunately still leaves breast tissue at the mastectomy site.  The kidney removal does not leave kidney tissue still in place.


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## bvilla7@brighthouse.com (Feb 28, 2015)

Thanks Debra.  I was having a hard time trying to explain it to them.  Your example is great.


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## rvalente (Mar 2, 2015)

blanca1402@att.net said:


> Thank Debra.  I totally agree but I am being questioned at work.  I guess they are confused because the kidney was removed and I coded it as history of because there is no treatment to the kidney site but there is treatment to the metastatic sites.  But where they are getting confused is why is breast cancer being coded with the primary breast code if the patient had a mastectomy and still requires treatment, how is it directed to the breast site if it was removed?



I would just like to add that in breast and prostate cancer patients they are usually on what is called "Adjunct" therapy after surgery. 

If the breasts or prostate have been removed, and they are on medication such as casodex or tamoxifen you can still code the disease as current.  With the rational that they are still being treated for the disease even if the cancer has been surgically removed.


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## balamurugan.ph (Mar 3, 2015)

Hi I would like to ask any time duration for coding History of cancer, for example patient having  breasts or prostate cancer and surgically removed (before 5 months) and document dose not support for further treatment like medication or radiation.





rvalente said:


> I would just like to add that in breast and prostate cancer patients they are usually on what is called "Adjunct" therapy after surgery.
> 
> If the breasts or prostate have been removed, and they are on medication such as casodex or tamoxifen you can still code the disease as current.  With the rational that they are still being treated for the disease even if the cancer has been surgically removed.


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## mitchellde (Mar 3, 2015)

Active vs history of cancer is not a time related issue.  It is dependent on whether the cancer is being treated, and if there is evidence of the disease.  If the provider ceases all treatment but the disease is still present, they simply switch to comfort care, the cancer is still coded active.  If the provider ceases treatment and indicates no evidence of disease at the primary site then it is history of at that moment.  Tamoxifen and lupron ( and other equivalents) treat breast cancer and prostate cancer for years after all other treatment has been discontinued.  Yet these drugs are treating active cancer cells at the primary site so the cancer is still active while on these drugs.  Many times a patient develops a secondary site either after the primary site us history or while still treating the primary site.  The secondary site is coded with the primary site either active or history whichever the documentation supports.  If both are active, the one currently being treated gets coded first.  If the secondary site is no longer being treated with no evidence of disease then you do not code it anymore, Since it is the same neoplasm as the primary site which is already coded.


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## rvalente (Mar 3, 2015)

Great reply Debra!


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## balamurugan.ph (Mar 3, 2015)

Thank you Debra...


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