# History diagnosis cancer coding



## Marianne614 (Jul 12, 2016)

I would like some feedback on coding for history cancer codes.  I know that you cannot code a history code for a primary diagnosis.  It is usually a Z08 or Z09, depending on disease.  Then a history code Z853 etc...  However, if their cancer is no longer active and the cancer has been resected/treated/no longer present BUT on ESTROGEN RECEPTORS, for example: Tamoxifan- Armidex. Would this still be the same in this case???  They can be on these for several years and not have cancer.  I know that the 5 year medical standpoint for the ICD9 is no longer set in place.  With the coding guidelines of ICD-10-CM would it be the same if they are on these receptor drugs????  If they are treated with adjunct therapy on chemotherapy I know it is a cancer code.  Please give me some professional advise.  I am trying to be a very precise and accurate coder in my new chosen career. It would be very appreciated...

Sincerely,

Marianne CPC


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## mitchellde (Jul 12, 2016)

The purpose of those drugs is to treat the cancer long term so it is not history of cancer it is the active cancer that you use.


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## Marianne614 (Jul 13, 2016)

*Cancer coding*

I would like more feedback from my reply...  I know that there are large fines for the doctors for coding an active cancer, that is "inactive" and has been "eradicated."  Sometimes they do not indicate that they are not on these estrogen receptors...  Like I said they can be on several different kinds of drugs for several years.  

Thank you very much.


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## stephanie.moore@wdhospital.com (Jul 14, 2016)

Here is a link to an article that was published last year that I believe you will find helpful. 

https://www.aapc.com/blog/30057-30057/

I don't want to mislead you as we are still using the guidance the AHA has provided in our facility as there has been no update that I am aware of but I thought this article was an interesting read. 


Herceptin maintenance    

Coding Clinic, Third Quarter 2009 Pages: 03 to 04 Effective with discharges: September 15, 2009


Question: 



A patient had a malignant breast neoplasm excised three years ago and has completed radiation and chemotherapy. Currently there is no evidence of residual disease on exam, on radiographic images or histologically. However, the patient is receiving consolidative treatment for breast cancer with Herceptin indicated for five years. How is maintenance on Herceptin coded?



Answer: 



Assign code 174.9, Malignant neoplasm of female breast, unspecified, as the first-listed diagnosis, since Herceptin is considered cancer treatment. Assign code V58.69, Long-term (current) use of other medications, for the Herceptin maintenance.



Herceptin therapy is not antineoplastic chemotherapy, but is a biological adjuvant treatment for women with breast cancers that are HER2 positive (with cancer cells overexpressing Human Epidermal Growth Factor Receptor 2). Herceptin is a type of targeted cancer therapy also referred to as a monoclonal antibody. The monoclonal antibodies are generated in the laboratory by reproducing a hybrid cell line, which is designed to produce a specific antibody protein. These antibodies attach to the cancer cells and signal the body's immune system to destroy them in a targeted attack. The drug is administered weekly for an extended time period via intravenous infusion or a central line. Herceptin is used to decrease the risk of the cancer recurring, stop cell growth and prevent cancer cells from continuing to grow.


-Steph


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## Marianne614 (Jul 14, 2016)

*Cancer coding*

That was very helpful.  I do my research when I code reports.  If you have a question ask it, because there really isn't a stupid question.  I read an article by Daniel Rowden - networker that sparked my interest.  He is a very intelligent man!  He had a page on coding for history of cancers.  He is a CDIP, CCS, CPC, COC, CPCO, CPMA, CIC, AHIMA Approved ICD-10-CM/PCS Trainer...  I just want to say thank you and that I am coding correctly then...

Sincerely,

Marianne


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