Wiki History of Breast Cancer and When It Should be Used

Create Wiki
J

jackie ramsey

Guest
Messages
19
Best answers
0
At what point do your providers decide to code Breast Cancer as History of (Z85.3)? We have a payer that is insisting that even while a patient is on adjuvant endocrine therapy for invasive breast cancer, that we should be coding the diagnosis as history of malignant neoplasm of the breast (Z85.3). Has anyone else encountered this issue? If so, would love to hear how you handled it.

Thanks in advance for your input!

Jackie Ramsey
Mitchell Cancer Institute
Mobile, AL
 
If the medication is treating the breast cancer, even if it is suppressing the recurrence then you code it as active. It can be history only when there is no evidence of disease and when there is no further treatment directed to the cancer cells.
 
That is our defense - I just don't know if anyone else has used it successfully. They are stating that the endocrine is prophylactic so it is not really "treatment" to the cancer. But I have been gathering data from NCCN and Up To Date to show that this is Adjuvant Endocrine Therapy and therefore the patient is still under treatment.
 
Our oncologists use a variety of hormones and we code all patients on hormone therapy as active cancer both male and female and have had no problems with payment. The hormone supression helps keep the cancer from returning in cancers that are hormone positive. We have seen patients decide to stop hormone therapy and have their cancer come back.

Hormone therapy is considered treatment by our oncologists.
 
You must log in or register to reply here.
Top