Oncology & Hematology Coding Alert

Question: Which ICD-9-CM codes do we report when a patient with a history of breast cancer is on tamoxifen as prevention and comes in for a follow-up?

Indiana Subscriber

Answer: You should use a V67.x code as the first-listed diagnosis, such as V67.2 (Follow-up examination following chemotherapy). Then add V07.51 (Use of selective estrogen receptor modulators [SERMs]) to indicate the use of tamoxifen and V10.3 (Personal history of malignant neoplasm of breast) for the history of breast cancer. This is the code order given by AHA’s Coding Clinic for ICD-9-CM (2008 Vol. 25, No. 4). Additionally, while not indicated in your question, if the estrogen receptor status is documented (such as ER+) you should also list V86.0 (Estrogen receptor positive status [ER+]).

Alternatively, if the patient presents for drug monitoring, then you should first assign V58.83 (Encounter for therapeutic drug monitoring), and then add V07.51 and any other appropriate secondary codes.

ICD-10-CM: The crosswalked ICD-10-CM codes, expected to be implemented Oct. 1, 2014, are:

·         Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm

·         Z79.810, Long term (current) use of selective estrogen receptor modulators (SERMs)

·         Z85.3, Personal history of malignant neoplasm of breast

·         Z51.81, Encounter for therapeutic drug level monitoring

·         Z17.0, Estrogen receptor positive status [ER+].