Dx coding ....history/active

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Can someone please help with dx coding for follow-up visit for breast cancer for radiation oncology . Patient has completed radiation therapy and they are on Arimidex,Tamoxifen from their primary oncologist and my provider documents no evidence of disease.
 

jrs7117

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curious too

I thought that I read that if the chemotherapy and or Radiation therapy was complete and the patient was on arimidex, etc you would code the Z79.711 for the drug therapy and then Z85.3 for history of breast cancer.
 

jrs7117

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curious too

I thought that I read that if the chemotherapy and or Radiation therapy was complete and the patient was on arimidex, etc you would code the Z79.711 for the drug therapy and then Z85.3 for history of breast cancer.

Julie Williams CPC, CHONC
 

mitchellde

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From the manufacturer, Arimedex is used for:
ARIMIDEX is approved for the initial treatment of postmenopausal women with hormone receptor-positive or hormone receptor-unknown locally advanced or metastatic breast cancer and for the treatment of postmenopausal women with advanced breast cancer that has progressed following treatment with tamoxifen. Patients with hormone receptor-negative disease and patients who did not previously respond to tamoxifen therapy rarely responded to ARIMIDEX.
so it is for the treatment of breast cancer, therefore you code the cancer as active.
 

ebredehoeft

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Tamoxifen and Arimidex

I found also on the sites by Arimidex and Tamoxifen the following:
Arimidex:
Class: Aromatase inhibitor hormonal therapy. Aromasin and Femara are other aromatase inhibitors.
Uses: Arimidex, used to treat postmenopausal women, typically is used to:
• reduce the risk of early-stage, hormone-receptor-positive breast cancer coming back after surgery and other treatments
• treat advanced-stage, hormone-receptor-positive breast cancer
Research presented at the 2013 San Antonio Breast Cancer Symposium showed that Arimidex can lower the risk of first-time, hormone-receptor-positive breast cancer in postmenopausal women at high risk who haven’t been diagnosed. Arimidex isn’t approved by the FDA for this use, but doctors may consider it a good alternative to other hormonal therapies approved to reduce risk in high-risk women.
It’s possible that the FDA may approve Arimidex to be used to reduce risk in high-risk postmenopausal women who haven’t been diagnosed.
Arimidex usually is taken for 5 years. Doctors may recommend that some women take it for a longer or shorter period of time.

Chemical name: Tamoxifen
Class: SERM (selective estrogen receptor modulator) hormonal therapy. Evista and Fareston are other SERMs.
How it works: SERMs block the effects of estrogen in the breast tissue by attaching to the estrogen receptors in breast cells.
Uses: Tamoxifen, used to treat men and both premenopausal and postmenopausal women, typically is used to:
• reduce the risk of early-stage, hormone-receptor-positive breast cancer coming back after surgery and other treatments
• shrink large, hormone-receptor-positive breast cancers before surgery
• treat advanced-stage, hormone-receptor-positive breast cancer, including metastatic breast cancer
• reduce breast cancer risk in undiagnosed women at higher-than-average risk of developing breast cancer
Tamoxifen usually is taken for up to 5 years, but women with advanced-stage breast cancer may continue taking tamoxifen as long as it is working well.

To me it seems like it is stating that it can be used both for Active Breast Cancer and as a Preventative when it is not "Active". If used as a preventative I would think we are to code it as History of breast Cancer and Z79.811 or Z79.810 depending on the drug. This is a very confusing topic as I find articles about this some say yes History of and others say no code active. :confused::)
 

thelton

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I'm running into this question with our group of breast imaging radiologists. Is there a more recent Coding Clinic which addresses this? Thank you!
 

jbrandt

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If the Arimidex and/or Tamoxifen is being used to prevent cancer recurrence then you'd code it as personal history of breast neoplasm (Z85.3) along with the Z79.811 or Z79.810 (depending on if they're receiving Arimidex or Tamoxifen). If the oral drug is being used as anti-hormonal treatment then code the cancer as active disease along with the appropriate Z79 code. Hope this helps!
 
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