Ob-Gyn Coding Alert

Question:

Tennessee Subscriber

Answer:

Your likely codes will be V51.0 or V51.8 (Aftercare involving the use of plastic surgery ...) and V45.71 (Acquired absence of breast and nipple).

You stated that the initial surgery transpired a couple of years ago. This means the patient definitely is in the "history of" period. Ask, why the nipple reconstruction now?  Your physician is probably not performing this reconstruction because she has cancer but for cosmetic purposes. Most payers will pay for this type of surgery, but you might have to jump through some hoops since it has been delayed for so long. 

Warning: Review your diagnosis history rules. You should code this patient as having a history of cancer, because she underwent surgery and (presumably) no longer has any cancer. While your physician is always checking her to be sure she does not have a recurrence, the initial treatment has been taken care of it. Therefore, you can't keep saying she has cancer when she does not. The verbatim rule in ICD-9 is: "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."