# Coding Cancer Patient in Remission



## nlaaron (Aug 25, 2011)

Can anyone tell me what is the best way to code a cancer patient in remission/NED that has  previously had chemo or radiation?  Would a V67 code be used as primary and then the history?  The followup is for their 3 year check for the cancer to run labs and such.

Thanks for any help.


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## jgf-CPC (Aug 25, 2011)

Here is past post from AAPC thread (Armen) that is excellent: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


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## nlaaron (Aug 25, 2011)

Thats not exactly what I was asking, the history of malignancy cannot be primary for the followup, I was wondering what should be used as my primary diagnosis if they are only being seen for their routine followup on their past cancer.  Should it be V67.2 or V66.2 if they had chemo before?


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## LindaEV (Aug 25, 2011)

Why can't the hx of ca code be primary?


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## nlaaron (Aug 25, 2011)

It says it in the ICD-9 codebook.


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## Mojo (Aug 25, 2011)

erin30 said:


> Can anyone tell me what is the best way to code a cancer patient in remission/NED that has  previously had chemo or radiation?  Would a V67 code be used as primary and then the history?  The followup is for their 3 year check for the cancer to run labs and such.
> 
> Thanks for any help.



Erin, I agree with you. I would use the V67.x, followed by the history code for continuing surveillance, since the cancer has been treated and no longer exists. During this follow-up visit, if the cancer has recurred and is documented, a diagnosis code should be used in place of the F/U code. This is part of the Chapter 18 guidelines.


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## jgf-CPC (Aug 25, 2011)

But the V67- states that the  condition has been fully treated and no longer exists. Aren't you checking to see if still in remission?


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## Mojo (Aug 25, 2011)

Good point, Jackie. Do we need more than "no evidence of disease" to code a surveillance code even if the cancer has not been treated in years? Providers usually do not use the term cured.


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## sthibo (Aug 25, 2011)

Some cancers do have stages of remission. An example would be Lymphoma. If the Lymphoma is in remission you still code it because it has not been eradicated. Others such as Breast or Colon cancer can be cured. If eradicated and no longer being treated it then becomes a history of that cancer. I hope this helps a little.


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## sujit.more (Apr 2, 2014)

yes i agree with sthibo.

all chronic systemic cancers can be coded in remission.
e.g. LYMPHOMA, LEUKEMIA, LYMPHOSARCOMA.



Sujit, CPC


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