Home Health ICD-9/ICD-10 Alert

Question: It was my understanding that if a patient completed all treatment for breast cancer and is on prophylactic treatment to prevent recurrence with say Tamoxifen or Arimidex, we shouldn't code the cancer as "history of" because they are still being treated.

Now that there are special V codes for the prophylactic use of estrogen and aromatase inhibitors, do we continue to code the breast cancer (174.9) with the V07.5x (Prophylactic use of agents affecting estrogen receptors and estrogen levels) codes ��" or do we now code V10.3 for history of breast cancer with V07.5x?

-- Oklahoma Subscriber

Answer: If your patient is receiving prophylactic treatment to ensure that the cancer does not return, you should list the V10.x "history of" code.

As for the V07.5x codes, notes from the September 2009 ICD-9- CM Coordination and Maintenance Committee Meeting mention proposed changes to the V07.5x codes due to confusion over their use.

These codes are intended to be used for any long-term use of the agents included in the subcategory, "regardless of whether the use was prophylactic or for active treatment." But there has been confusion over when to use these codes because the code title specifies "prophylactic use."

The proposed changes would broaden the titles of category V07.xx, subcategory V07.5x, and the codes under this subcategory to include treatment as well as prophylactic use.

The V07.5 codes have been on the eligible V code list in the past. When V codes are on that list, it means that the grouper will check M1024 for case mix diagnoses. In the most recent revision, however, the V07.5 subcategory has been removed. So far, no one has been able to determine whether the code was removed on purpose or whether it was left off the list unintentionally.

Bottom line: If the V code is not an "eligible" V code, then a resolved diagnosis -- cancer for example -- placed across from the V code will not earn case mix points.