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Old 02-03-2011, 02:31 PM
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Default Coding for post-op oncology visit with no further treatment

We are having a heated debate here on this subject. Here is the scenario:

Patient has cancer, let's just say colon cancer. Goes in for hemicolectomy. Surgery goes well, margins are clear, NED. Up to this point we are coding for the colon cancer.

Patient goes for his first follow-up visit with oncology. The oncologist decides that there will be no further treatment. How do you code this visit? Active or History of?

Some feel (myself included) that since the cancer has been excised and there is no evidence of disease, this visit should be treated as History of.

Others feel that since the purpose of this visit was to plan treatment, it should still be coded as active cancer. After this visit, however, it should be coded as History of. This leads us to a problem-- the oncologist never sees the patient again and never changes the diagnosis in the patient's problem list. It might remain there for years in error.

I'd like to hear your thoughts on this.
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Old 02-04-2011, 07:49 AM
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NED and no more treatment = history of. This is outlined in your Coding Guidelines which should be in the front of your book, or at least it's been in the front of every icd-9 book I've ever owned.

And I quote:

"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 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 as a secondary code."

Hope this helps!
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Old 02-04-2011, 03:16 PM
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Well, that was my position as well. I hope I can convince everybody else!
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Old 02-04-2011, 05:33 PM
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Show them the coding guidelines. It's right there in black and white. They can't argue with the official guidelines.
... Well, I suppose they can but that would be pretty ignorant of them. It's not about who is right and who is wrong, anyway. It's about doing things by the book, to avoid coding error and fraudulence.
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Old 02-07-2011, 10:22 AM
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OhnO, sorry if I am wrong. I just join here to debate for a healthy outcome not for who is wrong or right ( but just for the benefit of doubt); just a thought , alright?

I agree with OhnO and abide with the guidelines. but let us ponder at the outset, whether our claim about the eradication/ completion of the treatment for a cancer free site, is already met with at this stage of post surgery alone and say for sure that the Ca is eradicated or no longer needs treatment for a cancer free site or local invasion declaration.
Surgery alone (per se) mostly, is not the only curative treatment for even a primary site of malignancy, meaning, to declare that the treatment is complete/totally eradicated/ no longer exists/ or completed treatment.
Many of the malignancies need either or some of the adjuvant therapy like hormonal, radio, chemo therapy to say locally eradicated- as the condition warrants; Ie, the treatment modalitiy selection is under way/still under process.
We are not coming to the Secondaries yet at this stage of debate.

So what I feel is that I would not venture to say the malignancy is eradicated or cancer free site just with the excision or debulking of the tumor alone, until the doctor declares it cancer free site and no longer needs a treatment.
Hence I would not label it as history of at this juncture. I may be wrong as regards to coding compliance/payers point of view, but what I said is purely on clinical relevance.
Thank you for your time.
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Old 02-07-2011, 10:32 AM
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The oncologist has stated there will be no further tx and there is no evidence of disease. There fore it is hx of for coding purposes. It is not up to the coder to say whether there will be recurrence or a second opinion down the road that determines the need for adjunctive tx. There are many cancers can be eradicated with surgery alone it all depends on the specific nature of the neoplasm. As a coder that is not up to us. Coding from the documentation provided this is hx of.
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