Pathology/Lab Coding Alert

V code tells breast cancer type

Physicians can't justify the common breast-cancer drug Tamoxifen if they don't document lab results for estrogen receptor (ER) status. Now ICD-9 gives you two new V codes to do just that.

Medical necessity for some additional cancer testing also depends on ER status. Use one of the following new ICD-9 codes, effective Oct. 1, to document tumor ER status:

- V86.0--Estrogen receptor positive status (ER+)

- V86.1--Estrogen receptor negative status (ER-).

Use the V codes as a secondary diagnosis. -You should code the malignancy first as the primary diagnosis,- says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. You might commonly report V86.0 or V86.1 with codes from category 174.x (Malignant neoplasm of female breast) or 175.x (Malignant neoplasm of male breast).

-In fact, the October ICD-9 revision includes a note under these category codes directing you to the new V codes,- Witt says. The new note under 174 and 175 says, -Use additional code to identify estrogen receptor status (V86.0, V86.1).-

Distinguish Lab Tests

Your lab might perform a qualitative ER assay (88342, Immunohistochemistry [including tissue immunoperoxidase], each antibody), which involves test results that indicate either -yes- the antigen is present, or -no- the antigen is not present.

Or the lab may perform a more quantitative test--morphometric analysis--that involves counting stained cells from sections of the slide and reporting the results as either a numerical percentage or a semiquantitative-scale rating.

Do this: Select the appropriate quantitative/semiquantitative ER assay code based on whether the slide count is manual or computer-assisted:

- 88360--Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual

- 88361--... using computer-assisted technology.

Demonstrate Medical Necessity

Oncologists may use Tamoxifen (Nolvadex) for breast cancer treatment or prevention, says Kim Garner Huey, CPC, CCS-P, CHCC, a consultant with KGG Coding and Reimbursement Consulting in Auburn, Ala
.
If the physician documents that the medication is for treatment, report the appropriate code for malignant neoplasm of breast (such as 174.0, Malignant neoplasm of female breast; nipple and areola). If the physician instead says the patient's therapy is complete and the medication is for recurrence prevention, report V10.3 (Personal history of malignant neoplasm; breast).

In either case, you should report ER+ status using V86.0 to demonstrate medical necessity for Tamoxifen.

Note: The American College of Obstetricians and Gynecologists asked the ICD-9 committee to add a code for estrogen receptor status for use with breast malignant neoplasm codes. You can find the new codes for the latest ICD-9 update on the Internet at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdtab_addenda07.pdf.

Don't Miss Lab NCD Connection

Medicare adds V86.0 and V86.1 to the list of covered diagnoses in the National Coverage Determination for alpha fetoprotein. CMS updated the NCD list in Change Request 5293, issued Sept. 7.

ER receptor status is important for the prognosis of hepatocellular carcinoma. Physicians use the AFP assay to monitor HCC patients.