ED Coding and Reimbursement Alert

Question: If a patient has a diagnosis of cancer, how would I report this on the claim? Also, how does the ICD-9 coding change if the patient receives a "cancer-free" diagnosis from her physician?

Pennsylvania Subscriber

Answer: Cancer treatment can span many months. For example, a patient with breast cancer undergoes, in turn, a biopsy, mastectomy, chemotherapy and radiation therapy. The entire process takes about nine months. If this patient reported to the ED during this time for a cancer-related issue, you would report a diagnosis of 174.x (Malignant neoplasm of female breast -).

After the patient has completed radiation therapy and been declared cancer-free by her physician, you can apply a diagnosis of V10.3 (Personal history of malignant neoplasm; breast). Although the patient may continue to receive maintenance drugs or monitoring visits after this acute treatment phase, the history code is appropriate.

Of course, if the cancer recurs at the same site (meaning either the same breast or the other breast), you would drop the "history" diagnosis in favor of 174.x again.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.