Oncology & Hematology Coding Alert

Question: For how long after treatment can we use the cancer diagnosis code C56.9 for a patient of ovarian cancer who has completed treatment?

Alabama Subscriber

Answer: You should consider two options:

1. Code for primary malignancy
2. Code for personal history of malignancy

Confirm with your physician to determine if the cancer being treated is active or whether treatment has been completed and there is no evidence of disease. There is no timeframe after where it is acceptable to code personal history. You must determine at the time of service whether the documentation indicates the cancer is active or personal history.

When the patient is receiving treatment for the malignancy, you can use the ICD-10-CM code for that malignancy as their diagnostic code. More specifically and according to the ICD-10-CM Official Guidelines for Coding and Reporting, I.C.2.d, "When a primary malignancy has been previously excised or eradicated from its site AND there is no further treatment directed at that site AND there is no evidence of any existing primary malignancy, a code from the category Z85, personal history of malignant neoplasm, should be used to indicate the former site of the malignancy."

Only the clinician can make the determination for above criteria to determine whether the malignancy is active or personal history. When the documentation is not clear, query the physician and ask for clarification of the status in the documentation so an accurate code can be assigned.

When the malignancy is active, you will submit codes C56.1 (Malignant neoplasm of right ovary) and C56.2 (Malignant neoplasm of left ovary) for malignant neoplasms in the right and left ovary, respectively. When your physician does not document the laterality of the ovarian cancer, you can submit ICD-10-CM code C56.9 (Malignant neoplasm of unspecified ovary).

Alternatively, you may read the patient was found to have no evidence of malignancy and is not under active treatment. Instead, the patient is under medical surveillance for cancer recurrence. In this case, you may consider Z85.43 (Personal history of malignant neoplasm of ovary).