Oncology & Hematology Coding Alert

Question: Would you explain when it is appropriate to Question: Would you explain when it is appropriate to use a -history of- diagnosis on a patient? For example, a patient with breast cancer, post-mastectomy, is treated and one year later presents with metastatic lung from the breast. We code the lung mets as 197.0, but should we be using the V10.3 or the 174 code secondary to indicate the original primary site? 

Pennsylvania Subscriber

Answer: Great question. According to ICD-9 guidelines (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf), If you eradicated your patient's breast neoplasm, so that neoplasm no longer requires treatment, you should use V10.3 (Personal history of malignant neoplasm; breast) rather than 174.x (Malignant neoplasm of female breast).

If the physician documents metastatic lung from the breast, you are right to report that metastasis as 197.0 (Secondary malignant neoplasm of respiratory and digestive systems; lung).

Report 197.0 as the first-listed code and V10.3 as the secondary code.

Here's the exact language:

-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. 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- Section 1.C.2.d (page 22). The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.