Oncology & Hematology Coding Alert

Question: In 1987, we treated a patient's breast cancer with lumpectomy and radiation, but not with chemo or hormonal therapy. We also performed a radical mastectomy of the right breast. Now the patient has infiltrating ductal carcinoma of the left breast with positive internal mammary nodes. Can we code the past cancer as V10.3 (Personal history of malignant neoplasm; breast) in addition to using 174.9 for the current cancer?

Michigan Subscriber Answer: You are correct to report both the "history of" breast cancer and the current malignancy. Doing so demonstrates to the insurance company (and the super-databases collecting diagnosis information) the complexity of the patient's condition.

You should not use 174.9 for the current breast malignancy, however. At this point, the most specific ICD-9 code for infiltrating ductal carcinoma is 174.8 (Malignant neoplasm of female breast; other specified sites of female breast).

If you knew which specific anatomic area of the breast the cancer was located, you could provide an even more specific diagnosis code (for example, 174.2, ... upper-inner quadrant; or 174.1 ... central portion).