Oncology & Hematology Coding Alert

Master 'history of' codes before National Cancer Survivor's Day on June 4

If you think V codes only provide supplemental information, think again. In fact, they are key elements to successful claims.

See how you score when it comes to reporting -history of malignant neoplasm- codes. After you take the quiz, see the answers immediately following the questions.

Question 1: You perform a PSA test for a patient one year after successful prostate cancer treatment. What diagnosis code should you report?

Question 2: If your patient has a history of breast cancer, can she participate in the 2006 oncology demonstration project?

Question 3: Can you report a -history of- code as a primary diagnosis?

Question 4: True or False. If a patient presents only for chemotherapy to treat a malignant lung neoplasm, you should report V58.11 (Encounter for antineoplastic chemotherapy) and V10.11 (Personal history of malignant neoplasm; bronchus and lung).

Question 5: If a patient continues taking Tamoxifen after completing chemotherapy, what diagnosis code should you report?

Coding Quiz Answers:

Are you an ace at using -history of malignant neoplasm- codes in the V10.x range? Find out below.

Answer 1: You should not use a prostate cancer diagnosis code (185, Malignant neoplasm of prostate). Instead, report V10.46 (Personal history of malignant neoplasm; prostate).

Check V codes for patients whose disease process is no longer active. Forgetting to do this is a common mistake, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla. Mislabeling a patient as an active cancer patient could affect his ability to get health or life insurance or affect his treatment by other physicians for other conditions, Acevedo says.

Note: Report the PSA test with 84153 (Prostate specific antigen [PSA]; total).

Answer 2: No. The diagnosis code for a history of breast cancer (V10.3, Personal history of malignant neoplasm; breast) isn't one of the demonstration project's covered diagnosis codes.

The patient must have a primary diagnosis of cancer to participate in the demonstration project. For breast cancer, CMS requires the patient to have a primary diagnosis from the 174.0-174.9 series (Malignant neoplasm of female breast).

Answer 3: Sometimes -history of- codes are the most accurate descriptors of the reason for the patient encounter. ICD-9 doesn't designate the V10 codes (Personal history of malignant neoplasm) as either primary or secondary codes, meaning you can report them as either.

Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, a coding and billing company in Stoneham, Mass.

But you can't choose your codes based on payment. You should follow the official coding guidance available at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf.

Answer 4: False. Although your primary diagnosis code should be V58.11, you should not report a -history of- code for a neoplasm that is being treated now. Instead report a code such as 162.8 (Malignant neoplasm of trachea, bronchus, and lung; other parts of bronchus or lung), depending on the specific neoplasm being treated.

Why? -If the condition is still present or still being treated, you shouldn't use a personal history V code,- says Stacie L. Buck, vice president of Southeast Radiology Management.

Answer 5: The answer depends on the reason the oncologist provides the Tamoxifen.
 
If the oncologist orders the Tamoxifen for prevention, you may report V10.3 (Personal history of malignant neoplasm; breast).
 
But if this patient needs the drug to treat remaining cancer cells, you should report the ICD-9 code for breast cancer. Physicians may prescribe Tamoxifen as a breast cancer treatment because the drug slows the growth of cancer cells. If your documentation indicates the presence of cancer cells, you should report 174.9 (Malignant neoplasm of breast [female], unspecified), or preferably, a more specific code from the 174.x range (Malignant neoplasm of female breast).

Bottom line: The American Hospital Association's official coding guidelines say that once you have eradicated a malignancy and it requires no further treatment, you should use a category V10 code.