Revenue Cycle Insider

Question: When a patient comes back to our office after their cancer has been completely eradicated and they are no longer receiving treatment, should we use a personal history code from Z85.-, or is it more appropriate to code for a follow-up using Z08?

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Answer: You are correct in saying both Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) and a code from Z85.- (Personal history of malignant neoplasm) can be used for patients who are no longer being treated for an active cancer and whose cancer has been eradicated. In fact, the codes can be used in combination for cancer-free patients, which is why Z08 carries with it a Use additional code instruction telling you to use a code from Z85.- in addition toZ08.

Correct application of the codes is determined by the purpose of the encounter. Code Z08, per its descriptor, implies more than just the idea that the cancer has been “fully treated and no longer exists.” Per ICD-10-CM Guideline I.C.21.c.8, it also implies the patient is undergoing “continuing surveillance following completed treatment of a disease, condition, or injury.”

In other words, the key to using a follow-up care code such as Z08, as far as ICD-10-CM is concerned, is to verify that:

• The condition no longer exists,
• There is no ongoing treatment for the condition, and
• The patient is under surveillance for the condition.

For example, if a patient returns to your office two years after completing treatment for endometrial cancer, and the provider examines the patient to find the condition is still in remission, you’ll code Z08 first, followed by Z85.42 (Personal history of malignant neoplasm of other parts of uterus).

The Z85.- codes, on the other hand, are used to provide information about a patient’s past medical condition that is no longer active, per ICD-10-CM Guideline I.C.21.c.4. This is important information, as the history of an illness, even if no longer present, will help justify medical necessity for surveillance of the condition or for management or treatment options for other active conditions.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC