Oncology & Hematology Coding Alert

Question: A patient presents for chemotherapy to treat a secondary liver neoplasm. It metastasized from a primary colon neoplasm that was removed surgically and is no longer being treated. Which ICD-9 codes should I report?

Nevada Subscriber

Answer: You should represent your diagnoses by reporting the following codes in this order:

• V58.11 (Encounter for antineoplastic chemotherapy) as primary diagnosis if the primary focus of the encounter is for chemotherapy
• 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary) for the site being treated (liver metastasis)
• V10.05 (Personal history of malignant neoplasm of large intestine) to show the primary neoplasm is no longer present.

History hint: You should choose V10.05 rather than a primary neoplasm code, such as 153.x (Malignant neoplasm of colon), because you indicated the primary neoplasm was removed surgically and there is no longer treatment aimed at that neoplasm.

ICD-9 Official Guidelines support this use of a "history of" code: "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, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code" (www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm).

The official guidelines also indicate that if the patient presents solely for chemotherapy, V58.11 should be the first-listed code.