Oncology & Hematology Coding Alert

Question: If a patient has current breast cancer, instructions for the C50.- codes tell you to use an additional code to identify estrogen receptor status using Z17.0 or Z17.1. My question is this: Do you still use these additional codes if the patient has a history of breast cancer, even if there is no similar instruction accompanying Z85?

AAPC Forum Participant

Answer: You are correct in saying that the C50 (Malignant neoplasm of breast) codes have a Use additional code instruction telling you to add Z17.0 (Estrogen receptor positive status) [ER+] or Z17.1 (Estrogen receptor negative status [ER-]) as applicable. You are also correct in saying that no such instruction accompanies the Z85 (Personal history of malignant neoplasm) codes.

This is because estrogen receptor status is significant in determining the specific treatment for breast cancer. If the patient no longer has the cancer, and you are using Z85.3 (Personal history of malignant neoplasm of breast) to document that, then the patient is no longer receiving treatment. In this case, you are not obligated to report the patient’s ER status, according to the official guidelines, as either ER+ or ER- codes require C50 to be listed. Therefore, they are not applicable in this situation.