Pathology/Lab Coding Alert

V code tells breast cancer type Physicians can't justify the common breast-cancer drug Tamoxifen if they don't document lab results for estrogen receptor (ER) status. Now ICD-9 gives you two new V codes to do just that.

Medical necessity for some additional cancer testing also depends on ER status. Use one of the following new ICD-9 codes, effective Oct. 1, to document tumor ER status:

- V86.0--Estrogen receptor positive status (ER+)

- V86.1--Estrogen receptor negative status (ER-). Use the V codes as a secondary diagnosis. -You should code the malignancy first as the primary diagnosis,- says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. You might commonly report V86.0 or V86.1 with codes from category 174.x (Malignant neoplasm of female breast) or 175.x (Malignant neoplasm of male breast).

-In fact, the October ICD-9 revision includes a note under these category codes directing you to the new V codes,- Witt says. The new note under 174 and 175 says, -Use additional code to identify estrogen receptor status (V86.0, V86.1).- Distinguish Lab Tests Your lab might perform a qualitative ER assay (88342, Immunohistochemistry [including tissue immunoperoxidase], each antibody), which involves test results that indicate either -yes- the antigen is present, or -no- the antigen is not present.

Or the lab may perform a more quantitative test--morphometric analysis--that involves counting stained cells from sections of the slide and reporting the results as either a numerical percentage or a semiquantitative-scale rating.

Do this: Select the appropriate quantitative/semiquantitative ER assay code based on whether the slide count is manual or computer-assisted:

- 88360--Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual

- 88361--... using computer-assisted technology.

Demonstrate Medical Necessity Oncologists may use Tamoxifen (Nolvadex) for breast cancer treatment or prevention, says Kim Garner Huey, CPC, CCS-P, CHCC, a consultant with KGG Coding and Reimbursement Consulting in Auburn, Ala
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If the physician documents that the medication is for treatment, report the appropriate code for malignant neoplasm of breast (such as 174.0, Malignant neoplasm of female breast; nipple and areola). If the physician instead says the patient's therapy is complete and the medication is for recurrence prevention, report V10.3 (Personal history of malignant neoplasm; breast).

In either case, you should report ER+ status using V86.0 to demonstrate medical necessity for Tamoxifen.

Note: The American College of Obstetricians and Gynecologists asked the ICD-9 committee to add a code for estrogen receptor status for use with breast malignant neoplasm codes. You can find the new codes for the latest ICD-9 update on the Internet at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdtab_addenda07.pdf.

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