Wiki When to code history of and Metastatic

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bearps@comcast.net

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Hi - Can someone clear this question up for me. When do you consider the patient's cancer a history of. My problem is that I am having an issue as to when a patient had a cancer and then that cancer metastasizes. For example - Patient had breast cancer and was treated with RT and Chemo, now several months later the patient has been diagnosed with Bone Mets. I think we should code Bone Mets as primary and then history of breast as secondary. My provider and nurses think we should still be able to code breast cancer 174.x.
 
Hi

I agree with you. Look at the ICD-9 coding guidelines for Chapter 2: Neoplasms (d)

Basically it states that if there is no current treatment directed to the primary malignancy site, then code from category V10, Personal history of malignant neoplasm.
The secondary site may be the principal diagnosis and the history of; would be the secondary diagnosis.

Jeanne Plouffe, CPC, CGSC
 
bearps said:
Hi - Can someone clear this question up for me. When do you consider the patient's cancer a history of. My problem is that I am having an issue as to when a patient had a cancer and then that cancer metastasizes. For example - Patient had breast cancer and was treated with RT and Chemo, now several months later the patient has been diagnosed with Bone Mets. I think we should code Bone Mets as primary and then history of breast as secondary. My provider and nurses think we should still be able to code breast cancer 174.x.
Click to expand...

My 2 cents.

Wouldn't your primary diagnosis depend on what the physician is seeing the patient for? If the patient is being seen for bone mets and being treated for it then yes I would code mets as primary.

I would also code 174.x. There's no mention of NED to the breast in your note and wouldn't the pt normally receive 5-10 yrs estrogen/aromatase treatment? In your note you state that after several months the pt was dx'd with bone mets. If that is the case then I would code the breast cancer as active until all treatment is completed and the pt is NED, as per guidelines in jplouffe's response.
 
Tonyj said:
My 2 cents.

Wouldn't your primary diagnosis depend on what the physician is seeing the patient for? If the patient is being seen for bone mets and being treated for it then yes I would code mets as primary.

I would also code 174.x. There's no mention of NED to the breast in your note and wouldn't the pt normally receive 5-10 yrs estrogen/aromatase treatment? In your note you state that after several months the pt was dx'd with bone mets. If that is the case then I would code the breast cancer as active until all treatment is completed and the pt is NED, as per guidelines in jplouffe's response.
Click to expand...

I completly agree with Tonyj,

She is a newly diagnosed breast ca if she has only been in treatment for a few months now developing bone mets. She clearly still has active breast ca. History of breast ca would be used when the patient has completed treatment and gone for a period of time (this is a little gray... 6 months/year) post treatment without any NED.


I also wanted to add..if the provider and the RN is saying she still has active breast cancer, and it is documented as so, then absolutly use the correct 174._ needed.
 
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Thanks for the help!!

I was just trying to create an example because I have been battling this History of thing for a while with the clinics that I work with. Stating only a couple of months if definitely not realistic. Sorry for the confusion.

You are right if the patient was on estrogen/aromatase treatment, then we would still code breast cancer. The guidelines that I used when I was auditing medical records was 5 years.
 
what is the pt had a mastectomy and has bone mets. Would the breast still be considered active because they are receiving treatment for the mets from the breast?
 
The breast is still active if the breast site is still receiving treatment, if the breast site requires no further treatment and the provider indicates there is no current disease in the breast site then you code the bone mets and code the breast as history of. If the breast site is still undergoing treatment and the patient develops mets then you code both as active and sequence first that site which is being treated at that encounter. There is no time limit for active status it is history depending on the providers documentation.
 
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