Oncology & Hematology Coding Alert

Question: If a patient completes chemo treatment for breast cancer but now takes Tamoxifen, what diagnosis code should I use - V10.3 or 174.9?

Texas Subscriber

Answer: This common treatment is tricky for lots of coders. If the oncologist orders the Tamoxifen for prevention - as your example suggests - you may code "history of." But if this patient needs the drug to treat remaining cancer cells, you should report the ICD-9 code for breast cancer.
 
The American Hospital Association's official coding guidelines say that once you have eradicated a malignancy and it requires no further treatment, you should use a category V10 code. In this case, that would be V10.3 (Personal history of malignant neoplasm; breast). You can see the rules at www.cdc.gov/nchs/data/icd9/icdguide.pdf.
 
Physicians also prescribe Tamoxifen as a breast cancer treatment because the drug slows the growth of cancer cells. If your documentation indicates the presence of cancer cells, you should report 174.9 (Malignant neoplasm of breast [female], unspecified), or preferably, a more specific code from the 174.x range (Malignant neoplasm of female breast).