Wiki coding for Zometa

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jdavidson1

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The oncology practice I work for uses Zometa as aromatase inhibitor therapy following breast cancer. The aromatase inhibitor V07.52 is not on the CMS LCD as a covered diagnosis. Does anyone have any advice as to how to code this?:confused:
 
Coding Specialist

Per ICD-9 you would code first the malignant neoplasm (of the breast 174.0-174.9 or 175.0 to 175.9) (of prostate 185) followed by V07.52
You could also check with your physician to see if the patient has hypercalcemia of malignancy (275.42).
 
I guess I failed to mention the patient is history of breast cancer. ( Breast cancer, left mastectomy 1994, local recurrence 1998 s/p AC+T/Herceptin, radiation, clinically NED on Aromasin.) She receives zometa q 6 months ....any suggestions on coding this for the Zometa?
 
Cpc, cemc, chonc

In that case I would code first V10.3 followed by V07.52. Which payer are you having trouble with???
 
I'm not really having any trouble with a payor, we always get paid with the 174.9, v07.52 but I don't think coding this person with active breast cancer 174.9 would be accurate since its been 9 years. I am worried if I code with h/o and the v code it will not pay as it is not on the LCD as a diagnosis covered by medical necessity....just a little confused about Zometa covering the v07.52 and h/o.
 
jdavidson1 said:
I'm not really having any trouble with a payor, we always get paid with the 174.9, v07.52 but I don't think coding this person with active breast cancer 174.9 would be accurate since its been 9 years. I am worried if I code with h/o and the v code it will not pay as it is not on the LCD as a diagnosis covered by medical necessity....just a little confused about Zometa covering the v07.52 and h/o.
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It was my understanding that if the cancer is still being treated then we code it as an active disease. Only when there's NED and no treatment to the Ca do we utilize H/o. Therefore, I'd continue to use the breast Ca dx w/V07.52.
 
Per the Dr. note this is NED she is receiving Zometa b/c of the past treatment history of aromatase inhibitors (Breast cancer, left mastectomy 1994, local recurrence 1998 s/p AC+T/Herceptin, radiation, clinically NED on Aromasin) I just hate to use the breast caner dx since it has been 9 years and dr notes NED
 
Zometa is a proven treatment that can help reduce and delay bone complications caused by cancer that has spread to the bone. ZOMETA is approved to treat:
*Bone lesions from multiple myeloma, used with anti-cancer medications
* Bone complications from certain metastatic cancers that have spread to the bone—including breast, lung, and prostate cancer,* used with anti-cancer medications
*Hypercalcemia of malignancy (HCM), a condition resulting in high levels of calcium in the blood due to cancer

ZOMETA is used with anti-cancer medicines. ZOMETA is not an anti-cancer therapy.
therefore you code the history of breast cancer code.
 
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