Know When to Tie Receptor Status Codes to Breast Cancer Dx
Question: If a patient has current breast cancer, instructions for the C50.- codes tell you to use an additional code to identify estrogen, other hormones, and factors receptor status using a code from Z17.-. My question is this: Do you still use these additional codes if the patient has a history of breast cancer, even if there is no similar instruction accompanying Z85? Revenue Cycle Insider Subscriber Answer: You are correct in saying that the C50.- (Malignant neoplasm of breast) codes have a Use additional code instruction telling you to add a code from Z17.- (Estrogen, and other hormones and factors receptor status) as applicable. These include codes for positive and negative estrogen receptor status — Z17.0 (Estrogen receptor positive status (ER+)) and Z17.1 (Estrogen receptor negative status (ER-)) —codes for positive and negative progesterone receptor status — Z17.21 (Progesterone receptor positive status(PR+)) and Z17.22 (Progesterone receptor negative status(PR-)) — and combination codes for positive and negative hormone receptor status with positive and negative human epidermal growth factor receptor 2 status such as: You are also correct in saying that no such instruction accompanies Z85.3 (Personal history of malignant neoplasm of breast) even though the code instructs you to use a personal history code “for conditions classifiable to C50.-” per ICD-10-CM. This is because receptor status is only significant in a current breast cancer diagnosis as it helps to determine the specific treatment for the cancer. If the patient no longer has the cancer, and you are using Z85.3 to document that, the code implies the patient is no longer receiving treatment, then receptor status is no longer important to the diagnosis and, thus, reporting it is unnecessary. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
