# FH breast cancer



## twizzle (Mar 16, 2016)

I am an auditor, and when coding in ICD-9 there was a V code for high risk breast cancer screening. Now we're in ICD-10 there is no high risk Z code.

My question is about when to use Z80.3 (FH breast cancer). In ICD-9 they considered high risk to include a FH that involved mother, sister, or daughter, nothing else.

In the course of my auditing work now, I am of the opinion that Z80.3 really should only be coded when the FH involves mother, sister, daughter only. Anything else (paternal grandmother, cousin, paternal great aunt, all those kind of more distant relationships), do not really constitute a relevant FH. There has to be a cut-off point somewhere.

Does anyone have any opinions on this, and/or can anyone show me some supporting documentation to substantiate my theory. Any help would be much appreciated.

Thank you.


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## cathya35 (Mar 17, 2016)

*Family History*

I use ICD10data.com a lot to look up codes and the synonyms they list if I am not sure where a condition fits. Under Z80.3, family history of breast cancer, they list family history of breast cancer in a 1st degree or 2nd degree relative as synonyms (http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z80-/Z80.3). My thought is that if the doctor mentioned the family history as being significant then I would code Z80.3. 

Having a male relative with a history of breast cancer also increases your risk, as stated below (from http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors)

"Family history of breast cancer

Breast cancer risk is higher among women whose close blood relatives have this disease.

Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk about 3-fold.

The exact risk is not known, but women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, less than 15% of women with breast cancer have a family member with this disease. This means that most (over 85%) women who get breast cancer do not have a family history of this disease."


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## twizzle (Mar 17, 2016)

cathya35 said:


> I use ICD10data.com a lot to look up codes and the synonyms they list if I am not sure where a condition fits. Under Z83.0, family history of breast cancer, they list family history of breast cancer in a 1st degree or 2nd degree relative as synonyms (http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z80-/Z80.3). My thought is that if the doctor mentioned the family history as being significant then I would code Z83.0.
> 
> Having a male relative with a history of breast cancer also increases your risk, as stated below (from http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors)
> 
> ...



Hi Cathy.....thanks for the response. This is radiology (more specifically mammography) coding. What I really, really need to know is when to capture Z83.0. If the radiologist says " FH breast cancer in maternal/paternal aunt, cousin" that kind of thing, do we use Z83.0? I think that it should be used only if it involves mother sister, daughter. If we start using the code for any blood relative, no matter how distant, we can probably all claim to have some distant relative who has had the disease and use it for every encounter. Personally, I think that is wrong.

Can anyone shed any light on this please?


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## cathya35 (Mar 18, 2016)

*Relevant family history includes more than mother, sister, daughter*

Relevant family history for breast cancer includes more than just breast cancer in mother, sister, or daughter. If you look at the Tyrer-Cuzick model (which doctors commonly use to determine breast cancer risk), it includes mother, sisters, and daughters but also includes paternal grandmother, maternal grandmother, paternal aunts, maternal aunts, half sisters, cousins, and nieces (model is at http://www.ems-trials.org/riskevaluator/ and you can see family history screenshot in the screenshots and examples tab). I believe it would be correct to code Z80.3 if the family history is in a 1st or 2nd degree relative, as supported by icd10data.com and this model, but of course I could be mistaken. I wouldn't code it for any blood relative, no matter how distant, but would code it for those blood relatives that medical providers and risk prediction models are currently looking at to try to determine a woman's risk. If you are still not sure, I would query the physicians or facility that you are coding for and ask what they consider to be a relevant family history and when you should code Z80.3.


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## stephanie.moore@wdhospital.com (Mar 18, 2016)

If the clinician documents I feel there is a reason for it and I would code it as such. This link to the Susan B Komen website may be helpful to you. 

http://ww5.komen.org/BreastCancer/FamilyHistoryofBreastOvarianorProstateCancer.html


Hope this helps,


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## twizzle (Mar 18, 2016)

Thank you both for your very helpful responses. I will share this information with my colleague and manager. Looks like I will have to change my auditing of the Z80.3 to include the other relatives.
We learn something new every day in this job don't we?


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