Oncology & Hematology Coding Alert

Question: In a patient with an established history of prostate cancer, our oncologist detected secondaries in the right femur. The patient sustained a fracture in the femur and is now on morphine for pain control and the fracture is healing well. What diagnosis codes can we use for these conditions in ICD-10-CM?

New York Subscriber

Answer: Your question indicates the patient has an “established history of” prostate cancer.  However, it is unclear whether the condition is truly historical as defined by ICD-10-CM.  You may submit code Z85.46 (Personal history of malignant neoplasm of prostate) if the prostate cancer is documented as historical (and there is no evidence of disease). However, if the prostate cancer is still being treated or still present, an active ICD-10-CM for the condition, C61 (Malignant neoplasm of prostate) would be more appropriate. For “secondaries” or malignancies found in the right femur, you would select the ICD-10-CM code C79.51 (Secondary malignant neoplasm of bone). Since the patient had a fracture that is being treated, you also report code M84.551D (Pathological fracture in neoplastic disease, right femur; subsequent encounter for fracture with routine healing). Lastly, for neoplasm related pain, you report code G89.3 (Neoplasm related pain [acute] [chronic]) and for treatment with morphine, you may report code Z79.891 (Long term [current] use of opiate analgesic).