Correct reporting of cancer diagnosis---current vs. personal history

[AHVC]

Question--The patient had a lumpectomy 3 years ago for breast cancer, the IM doctor is treating the patient with Arimidex and will continue to do so for 5more years. The patient does not currently have breast cancer, a recurrence of breast cancer, or metastasis per the provider. The provider and the medical director say if a patient is on arimidex, femara or tamoxifen, they are receiving treatment for breast ca and can be coded as such and not history of.

Many of us disagree with the ruling and would like to hear your feedback on this and if you have any specific resources outside of the normal ones that can provide reference either supporting this ruling or supporting our opinion that it should be coded as personal history of.

 

[lovetocode]

According to ICD-9-CM Official Guidelines for Coding and Reporting found on the website www.cdc.gov:

"Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring."

After reading this, I would agree with the provider and medical director and say you cannot code for personal history but should code for the breast neoplasm.

 

[moinsf]

Correct reporting of cancer diagnosis -- current vs. personal history

I have been trying to find as much information as possible on this subject in order to educate the providers where I work. I have read the coding guidelines extensively and had the same question -- was Arimidex considered to be treatment for breast CA as it is hormonal and not necessarily a chemo drug. I also agree though that if it is being given as a treatment for breast CA then the diagnosis code would be in the 174 category and not in the history category. If anybody else has resources regarding this information, please post them.

It seems that a lot of physicians use the neoplasm code when the history of code should be used. These are in the cases where the neoplasm has been resected and the patient is status post chemo treatment and radiation treatment.

 

[cacaffey]

Current vs History

http://www.optumcoding.com/optuminsider/

There is lots of good info from optum on the subject.

Bottom line, hormone therapy is active treatment and cancer should be coded as current (even when it has been surgically removed)

 

[LTANNER1974]

Correct reporting of Cancer Diagnosis

AHA Coding Clinic 3rd Q 2009 Pgs 3-4 is a great example of this scenario with a response.

Patient with excised malignant breast neoplasm excised 3 years ago and completed radiation and chemo. The patient is currently on Herception maintenance.
AHA states the active cancer 174.9 should still be coded with V58.69 for Herceptin maintenance for as long as the patient is on the adjuvant or hormonal therapy.