Oncology & Hematology Coding Alert

Question: How should we code a metastatic breast cancer in which the breast was removed in the 1980s but the cancer has returned in the lung? New Jersey Subscriber Answer: AHA guidelines dictate that "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 [Personal history of malignant neoplasm] used as a secondary code."

The cancer that they found at this episode is a lung cancer, so it should be coded as secondary lung (197.0) followed by V10.3 (Personal history of breast cancer). Answers to the Reader Questions and You Be the Coder were provided by Mary Jo Griffin, RN, CPC, compliance officer with Practice Management Inc. of Boise, Idaho; Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.; Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm; and Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett.