Wiki Hx of Breast CA pt, with Osteopenia no longer on Aromatase Inhibitor

[emonet01]

I am reaching out today on behalf of our coding team looking for some advice...

We have been struggling with coding Zometa for Osteopenia lately. One of our struggles are the pt's that have a Hx of Breast CA, they have Osteopenia, but they either are no longer on an Aromatase Inhibitor, they are on Tamoxifen (Z79.810) OR they never received treatment from with an AI. The CMS Article for Zometa states that in order to report M85.80 for Osteopenia, you have to also code Z79.811 and Z85.3. If the pt is no longer on the AI, then are we correct in our thought that we are no longer reporting the Z79.811 since that is no longer an active medication. Medicare does not seem to like it when we just code the Osteopenia or the Osteopenia with the Hx of Breast CA.

I would love to hear the thoughts of other coders. Thanks!

 

[rachaelwilleford]

I am reaching out today on behalf of our coding team looking for some advice...

We have been struggling with coding Zometa for Osteopenia lately. One of our struggles are the pt's that have a Hx of Breast CA, they have Osteopenia, but they either are no longer on an Aromatase Inhibitor, they are on Tamoxifen (Z79.810) OR they never received treatment from with an AI. The CMS Article for Zometa states that in order to report M85.80 for Osteopenia, you have to also code Z79.811 and Z85.3. If the pt is no longer on the AI, then are we correct in our thought that we are no longer reporting the Z79.811 since that is no longer an active medication. Medicare does not seem to like it when we just code the Osteopenia or the Osteopenia with the Hx of Breast CA.

I would love to hear the thoughts of other coders. Thanks!

They don't like it because it's not indicated if the patient is no longer on an aromatase inhibitor. Indications are osteoporosis (with multiple causes), prevention in bone loss in prostate cancer, and prevention in bone loss in women with breast cancer on aromatase inhibitor treatment. Patients who are being treated for osteoporosis can still receive once they are osteopenic because 1) you can establish the osteoporosis that has improved with treatment and 2) once you take the treatment away, studies have shown that the patient's bone density will worsen. This isn't so with the breast related. (As explained to me by one of our oncologists and the pharm rep)