Oncology & Hematology Coding Alert

Question: Suppose a patient presents for periodic visits to see if a colon carcinoma has recurred. She has been clear for five years. Should we report the "history of" diagnosis along with V67.2?

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Answer: If the oncologist documents that there is no sign of the carcinoma recurring and chemotherapy was the last treatment provided, you should sequence V67.2 (Follow-up examination; following chemotherapy) first, state the ICD-9 official guidelines (effective Oct. 1,2009). Then you may report the "history of" code (such as V10.05, Personal history of malignant neoplasm; large intestine) on the same claim to provide the full picture of a "healed condition and its treatment," the guidelines indicate.

But if the carcinoma has recurred, the guidelines instruct you to report the active disease/recurrence diagnosis (such as 153.x, Malignant neoplasm of colon ...) instead of the follow-up code.

Crucial: Codes V67.x and V10.x are specific to conditions that have been fully treated and no longer exist. As a follow-up code, you use V67.x "to explain continuing surveillance following completed treatment of a disease, condition, or injury," the guidelines state. Similarly, V10.x is appropriate when "a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy," the ICD-9 coding guidelines instruct.

Resource: You can download the latest guidelines from www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm.