You Be the Coder:
No Cancer Now? Then Do Not Use Cancer Code
Published on Sun Jul 25, 2010
Question:We have a claim for nipple reconstruction the payer is denying. The ob-gyn has previously diagnosed the patient with breast cancer and did the surgery to remove it several years ago. Should I code the patient as still having breast cancer or code her as a history or status post breast cancer?Tennessee SubscriberAnswer:Your likely codes will be V51.0 or V51.8 (Aftercare involving the use of plastic surgery ...) and V45.71 (Acquired absence of breast and nipple).You stated that the initial surgery transpired a couple of years ago. This means the patient definitely is in the "history of" period. Ask, why the nipple reconstruction now? Your physician is probably not performing this reconstruction because she has cancer but for cosmetic purposes. Most payers will pay for this type of surgery, but you might have to jump through some hoops since it has been delayed for so long. Warning: Review your diagnosis history [...]
