Oncology & Hematology Coding Alert

Question: When a new patient comes in to establish care with one of our oncology providers for a history of cancer, can we still code this with Z08 as the primary? The history of cancer code is an unacceptable primary code but it is not technically a follow-up visit either.

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Answer: ICD-10-CM guidelines do not state that you shouldn’t use Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) as a first-listed diagnosis. In fact, guideline I.C.21.a tells you that “Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.”

With that in mind, you can code the encounter with Z08 along with a code from Z85.- (Personal history of malignant neoplasm) per the Use additional code instruction for Z08. But you should ensure the encounter fits the criteria outlined in ICD-10-CM guideline I.C.21.c.8, which tells you to assign Z08 providing the patient is no longer being treated for the condition or for any sequela or consequences from healing after being treated for the condition itself.