Pathology/Lab Coding Alert

Answer: The general rule for ICD9 Coding is to report the reason for the test using the most definitive information known at the time of billing. Your question exposes many of the nuances that fall into "gray areas" under that general rule.

First, it is up to the treating physician to determine when to change a diagnosis from "malignancy" to "history of cancer." The physician generally does so when the patient is cancer-free, often once the global period of the procedure that removed the cancer has ended. The American Hospital Association's coding clinic guidelines state that "history of cancer" diagnoses should be used once the tumor has been removed, treatment has ended and there is no evidence of recurrence. The ICD-9 standard is different from cancer registry standards, which typically expect five years to elapse before a diagnosis of cancer is removed.

For the pathologist's evaluation of a colon biopsy (88305, Level IV Surgical pathology, gross and microscopic examination, colon, biopsy) taken two years after successful treatment for colon cancer, report V10.05 (Personal history of malignant neoplasm; large intestine) rather than 153.3 (Malignant neoplasm; sigmoid colon) as the reason for the test. You should report the V code as the primary diagnosis regardless of the biopsy results.

If the biopsy demonstrates a tumor recurrence, you should also report the correct diagnosis for the cancer (153.x, depending on the location).