Home Health ICD-9/ICD-10 Alert

Question: We're seeing a patient for metastatic cancer with no symptoms present from the primary site. Should we code the primary site as the primary diagnosis and list the metastatic site next?
 
Answer: When coding cancer, you must consider the focus of care for that episode. If the focus of care is the primary site of the cancer, then you'd code that site first. If the focus of care is the secondary site of the cancer, then you'd code that secondary site first.
 
In this particular scenario, the focus of the care is the secondary site, so you should list that site as primary (or V58.42 if you're providing aftercare following surgery for neoplasm). Because there are no symptoms present from the primary site, the coder must consider whether the primary cancer is still present.
 
If the cancer is still present, then code the numeric code for the cancer. If the primary cancer has been eradicated (resected, treated and is no longer present), then you should use the appropriate V10 code for the history of malignant neoplasm as a secondary code to indicate the site of the former malignancy. The secondary site may be the principal diagnosis with the V10 code used as a secondary code.