Primary Care Coding Alert

Question: When should I use a diagnosis of family history of malignant neoplasm rather than a cancer code? For instance, when my FP treats a patient who has liver cancer, when should I report a V code rather than the neoplasm code?

Alabama Subscriber

Answer: ICD-9 coding distinguishes between these diagnoses based on whether the cancer is active. When your physician treats the malignancy, or the patient recently completed chemotherapy and the outcome is not known, you should assign the appropriate neoplasm diagnosis, such as 155.0 (Malignant neoplasm of liver and intrahepatic bile ducts; liver, primary). On the other hand, once the disease is inactive, meaning the tumor is removed, treatment has ended and no evidence of recurrence exists, you should use the diagnosis of personal and family history of malignant neoplasm (V10.07, Persons with potential health hazards related to personal and family history, personal history of malignant neoplasm; liver).

For example, a patient moves to a new city and establishes with a new FP and mentions a history of liver cancer 10 years ago. For this initial visit, you should use V10.07 as a secondary diagnosis code to explain that the patient no longer has the disease. In this visit and others in which cancer is a documented underlying concern, the physician may use the prior illness to support an increased level of medical decision-making.

Detailed documentation is also crucial to select the appropriate ICD-9 code for neoplasm versus history. If documentation is insufficient to tell whether the patient's cancer is active or inactive, ask your FP for further details Labeling a patient with an active diagnosis when a patient is cancer-free can cause major insurance problems for the patient. If that person seeks other types of insurance, such as life insurance, or has to change carriers, the company may rate the individual as an increased risk and charge higher premiums.