Oncology & Hematology Coding Alert

Reader Question:

5-Year Rule Doesn't Apply to ICD-9 Coding

Question: When should we replace a cancer diagnosis code with a "history of cancer" diagnosis code?

Pennsylvania Subscriber

Answer: Although cancer registries typically require that five years elapse before removing a cancer diagnosis, that rule does not apply to physician ICD-9 coding.
 
If the patient is cancer-free, you should use a diagnosis of personal history of cancer for any procedure that you subsequently report. The American Hospital Association's Coding Clinic guidelines state that you should report "history of malignancy" once a physician has removed or eradicated a tumor, when treatment is no longer directed to the tumor site, and when there is no evidence of remaining malignancy. At that point, you should report the appropriate V10.x code (such as V10.52, Personal history of malignant neoplasm of kidney) as your diagnosis code for these visits.

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