Wiki Need advice help!

[Love Coding!]

Hello,

I have a physician that would state in his dictation, the patient has a history of renal cancer. Does not indictate in his dictation that the patient in under chemo, in remission, etc. something that indicates that the patient has active cancer. But he bills 189.0. Now, if he is billing this code he is basically letting the insurance know that the patient still has active renal cancer. Am I correct in saying this? Any help will be appreciated.

Second part to that question - If the patient is in remission do you use a V code or an ICD-9 code?

GeminiCoder74

 

[Belinda Frisch]

V-code for Personal History

After the patient has recovered and is seen for follow-up treatment (or for other unrelated visits), the V-code for the personal history of malignancy should be assigned. This is especially crucial for patients who are undergoing biopsies of other areas to determine whether another malignancy exists. Also, ICD-9-CM provides a section of codes for family history of certain malignancies. These codes are important because heredity does appear to play an important role in some neoplasms and the presence of these codes adds an important piece of information to the record. In addition, in some cases, the family history code, such as code V16.0 for family history of colon CA, affects medical necessity for some services. Coders should be diligent however, in differentiating between personal history and family history of malignancy codes. For the vast majority of cases, no history code is reported when the patient has had a prior benign neoplasm, with one exception. For a personal history of a benign brain tumor, code V12.41 should be coded. Unlike most benign neoplasms that are not generally a persistent problem once treated, benign neoplasms of the brain often recur and can be difficult to treat. In addition, benign neoplasms of the brain may be life threatening. Refer to Coding Clinic, 4th Quarter 1997, p. 48, for this guideline.

http://health-information.advanceweb.com/editorial/content/editorial.aspx?CC=30707

 

[dwaldman]

http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm#guidelines

In ICD-9 coding guidelines, it says, "There are two types of history V codes, personal and family. Personal history codes explain a patient's past medical condtion that no longer exist and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring."

Page 25
"Primary malignancy previously excised
When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used...."