# breast dx coding--asc setting



## kandimcm (Dec 8, 2009)

hi all! i have a doc that dictates a patient has personal history of breast cancer at age 51. pt was born 1958 making the pt 51 this year. would you code current (174.9) or history (v10.3)? also, i've had some where they dictate personal history of breast cancer and then state that the malignant biopsy was just performed a couple months prior, etc.....again, current, or history? thank you all so much!!!!


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## mitchellde (Dec 8, 2009)

If the patient is no longer undergoing treatment and there is no evidence of disease then it is hx of.  If the patient is receiving tamoxifen then it is still considered active tx and therefore active cancer.  Age of the patient is no indicator.  If the bx was performed only a couple of months ago then chances are it is still active as treatment is usually longer than a couple of months.


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## jharrell (Dec 9, 2009)

Debra, I have heard that before about if you are still taking medication for the cancer then it is still active. We were just talking about that at work. Is their anything in writing that I can show my supervisor?

Thanks, 
Jessica Harrell, CPC


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## mitchellde (Dec 9, 2009)

There is the 1985 M-J coding clinic that states this.  Also the indication for the medication in the drug book states for cancer.


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## kmnjohnson (Mar 25, 2010)

mitchellde said:


> There is the 1985 M-J coding clinic that states this.  Also the indication for the medication in the drug book states for cancer.


To clarify for this situation - 
If a patient had breast cancer, surgically removed, and is now just on the hormonal therapy (eg Tamoxifen) do we code this as HX of or current CA due to the fact they are still receiving cancer "therapies"...? 

The ICD-9-CM guidelines, Chapter 2: Neoplasms, d. Primary malignancy previously excised: 
"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".

Is there a more recent resource than the 1985 M-J coding clinic? 
Thank you!


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## mitchellde (Mar 25, 2010)

No the 1985 still stands, also when in your reference you see where it says "...there is no further treatment directed to that site..."  Tamoxifen is a drug to treat cancer at that site, so you are still treating it.  If you look in the drug book tamoxifen states it use is to treat breast ca.  When there is a metastatic site we do list it first if this vist is for treatment at that site and the hx of code if it is hx of.  If the breast ca is still acitve then it is active.  so say breast ca with bone mets and this vist is for the bone mets treatment, if the breast ca is still undergoing treatment then it would be coded as
198.5
174..9
if we are treating the breast at this visit
174.9
198.5
My point is it is possible to have multiple active cancers and we will code them as such.  We always list a primary for the metastatic cancers whether active or hx of or unknown.  Remember the metastatic sit is just the primary ca moved to a different organ, so you could say the pat has breast cancer in the bone, that would be breast primary with bone mets.
I hope that helps


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