Oncology & Hematology Coding Alert

Question: I am sure I read somewhere that if a patient with a prior surgical removal of a breast was still on Tamoxifen that she should be coded to 174.x rather than history of, V10.3. I am unable to find the specific documentation to prove the validity of this. I have been told that a patient with surgical removal who is receiving anti-estrogen therapy should be coded to 174.x, but I am being told that Tamoxifen is used only as a prophylactic and is not considered treatment. Which is correct?

Nebraska Subscriber

Answer: If a patient is on active therapy for treatment of her malignancy, the correct diagnosis code to use is the one for the disease, in this case 174.x (malignant neoplasm of female breast). You may also need to include codes for the treatment, such as V58.0 for radiation and V58.1 for chemotherapy. These codes are still somewhat payer specific, however, and may or may not be recognized by your payers.

In this specific example, the patient is receiving Tamoxifen as primary treatment for breast cancer. This should clearly be coded as 174.x. Tamoxifen is well documented as a treatment for breast cancer, and prophylactic use should not be confused with its role in treatment.

This question was answered by Elaine Towle, practice administrator for New Hampshire Oncology and Hematology in Hookset, N.H.