Oncology & Hematology Coding Alert

Question: To use a -history of- neoplasm diagnosis code, how many years does the patient need to be disease-free? Also, what if the patient is on Tamoxifen? Should I consider the patient disease-free while this treatment was being administered?

Oregon Subscriber

 Answer: According to official ICD-9 guidelines, you should use the V10 code category (Personal history of malignant neoplasm) when the neoplasm is eradicated and no longer requires treatment, rather than a specific number of years.
 
Tamoxifen use is case-specific, so the provider needs to document why he prescribed the medications. Is the
patient disease-free and the provider prescribed the medication to prevent recurrence? Then you could report a -history of- code.
 
Or is the doctor ordering the medication as treatment for a present disease? Then you should report a neoplasm code (such as 174.x, Malignant neoplasm of female breast).