Otolaryngology Coding Alert

Question: A patient completed radiation treatment for tongue cancer. Less than five years postoperatively, she came in for a follow-up. My ENT wants to report personal history code V10.01. Should he?

Wyoming Subscriber

Answer: The otolaryngologist is right. You should treat the patient's cancer as a current cancer until the patient is cleared in five years. After that, it becomes a history. Thus, the V10.01 (Personal history of malignant neoplasm of tongue) applies. ICD-9 has official guidelines on primary malignancy previously excised. It states:

"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."

Protect yourself: To avoid getting into some hot water, discuss the guidelines with your doctor. At the end of the day, he still decides and you comply. If you're still concerned about his decision, you can prepare a memo for record as a safety net.