Breast Reconstruction w/active cancer code

[roslyn jones]

I am looking for assistance with this scenario. Patient has breast cancer excised 3 years prior and has had multiple treatment reconstruction's since then.
Do we code a history v-code or an active cancer code? Per the History guideline it states: "If a condition is still present or if the patient is still under treatment for the condition a history code is not reported." Would this breast reconstruction be considered treatment. Any assistance with this would be so very helpful.

 

[mitchellde]

No the breast reconstruction is not cancer treatment. If your patient is still receiving tamoxifen or it's equivalent then that is syllable active cancer treatment, however if all treatment has ceased and there is NED then it is history, there is a V code for this very purpose thought that states reconstruction following mastectomy.

 

[ABonnell CPC]

This can be confusing. I have some payers that require the cancer dx in order for the claim to be paid. The payer coding requirements don't always match those of the coding guidelines.

 

[mitchellde]

This can be confusing. I have some payers that require the cancer dx in order for the claim to be paid. The payer coding requirements don't always match those of the coding guidelines.

ICD-9 CM coding guidelines always prevail except for work comp. page one of the guidelines paragraph 3 states that adherence to the guidelines is mandated under HIPAA. the V10- codes are cancer dx codes. Remember always this is the patient's diagnosis not the yours or the payers, we must be correct for the patient always.

 

[mitchellde]

This can be confusing. I have some payers that require the cancer dx in order for the claim to be paid. The payer coding requirements don't always match those of the coding guidelines.

ICD-9 CM coding guidelines always prevail except for work comp. page one of the guidelines paragraph 3 states that adherence to the guidelines is mandated under HIPAA. the V10- codes are cancer dx codes. Remember this is the patient's diagnosis not yours or the payers, we must be correct for the patient always.