Orthopedic Coding Alert

Question: We assisted an oncologist in treating a patient with secondary cancer of the femur two years ago. We see her every year to evaluate fracture risk and bone density. When should we replace the cancer diagnosis with a "history of cancer" diagnosis code?

Pennsylvania Subscriber

Answer: Although cancer registries typically require a five-year period to elapse before allowing you to remove a cancer diagnosis, that rule does not apply to physician ICD-9 coding.
 
If the patient is cancer-free, a personal history of cancer diagnosis should be used for any procedure that you subsequently report (typically, you do this once the global period of the procedure that removed the cancer has ended). The American Hospital Association's Coding Clinic guidelines state that you should report "history of cancer" once the tumor has been removed, treatment has ended and there is no evidence of recurrence. You should, therefore, report V10.81 (Personal history of malignant neoplasm of other sites; bone) as your diagnosis code for these visits.