History of vs active cancer. Please help

donniruth

Contributor
Messages
18
Location
Lynchburg, VA
Best answers
0
AAPC: What would you do???

Case Overview:
Patient has Metastatic renal cell carcinoma status post nephrectomy with pulmonary metastasis. Coding Z51.11, C78.00, Z85.528 (patient currently on Avastin) . Foundation assistance approved for C64.2 Mal Neo Kidney.

Issue I’m solving for: Is it acceptable to still code metastatic RCC? Foundation will not pay with other codes that are following traditional rules of coding.

Supporting rationale:
According to ICD-10-CM Official Guidelines for Coding and Reporting:
Primary malignancy previously excised When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the Z85 code used as a secondary code.

Clinical Argument in Opposition:
The metastatic tumor that forms is comprised of the same type of cancer cells as the original or “primary” tumor. If RCC spreads to the bone, for example, the cancer cells in the tumor that forms there are cancerous renal cells and the cancer is still called metastatic renal cell cancer rather than bone cancer.
********************************************************************************
My Thoughts: This patient had renal carcinoma in 2012 and it was removed and she had no further treatment. In 2016, she has metastatic cancer to the lungs. I have coded it as C78.01 with Z85 for history of renal cancer. I am being asked to change this to a current active cancer, C64.2 and I am needing help. I found the excerpt below from 2013. Has anything changed?


AAPC states:

You cannot ignore the guidelines. The guidelines are very clear. Once the neoplasm has been excised or destroyed and is no longer being actively treated it is coded to a history code. It would be inappropriate to code it as an active cancer because it does not met the standards of the guidelines. I know your physician may not like it but it is the guidelines.

1. When to code history of and Metastatic
Hi - Can someone clear this question up for me. When do you consider the patient's cancer a history of. My problem is that I am having an issue as to when a patient had a cancer and then that cancer metastasizes. For example - Patient had breast cancer and was treated with RT and Chemo, now several months later the patient has been diagnosed with Bone Mets. I think we should code Bone Mets as primary and then history of breast as secondary. My provider and nurses think we should still be able to code breast cancer 174.x.
ANSWER: Look at the ICD-10 coding guidelines for Chapter 2: Neoplasms (d)

Basically it states that if there is no current treatment directed to the primary malignancy site, then code from category Z85, Personal history of malignant neoplasm.
The secondary site may be the principal diagnosis and the history of; would be the secondary diagnosis.
 

npricercm

Guest
Messages
282
Best answers
0
AAPC: What would you do???

Case Overview:
Patient has Metastatic renal cell carcinoma status post nephrectomy with pulmonary metastasis. Coding Z51.11, C78.00, Z85.528 (patient currently on Avastin) . Foundation assistance approved for C64.2 Mal Neo Kidney.

Issue I’m solving for: Is it acceptable to still code metastatic RCC? Foundation will not pay with other codes that are following traditional rules of coding.

Supporting rationale:
According to ICD-10-CM Official Guidelines for Coding and Reporting:
Primary malignancy previously excised When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the Z85 code used as a secondary code.

Clinical Argument in Opposition:
The metastatic tumor that forms is comprised of the same type of cancer cells as the original or “primary” tumor. If RCC spreads to the bone, for example, the cancer cells in the tumor that forms there are cancerous renal cells and the cancer is still called metastatic renal cell cancer rather than bone cancer.
********************************************************************************
My Thoughts: This patient had renal carcinoma in 2012 and it was removed and she had no further treatment. In 2016, she has metastatic cancer to the lungs. I have coded it as C78.01 with Z85 for history of renal cancer. I am being asked to change this to a current active cancer, C64.2 and I am needing help. I found the excerpt below from 2013. Has anything changed?


AAPC states:

You cannot ignore the guidelines. The guidelines are very clear. Once the neoplasm has been excised or destroyed and is no longer being actively treated it is coded to a history code. It would be inappropriate to code it as an active cancer because it does not met the standards of the guidelines. I know your physician may not like it but it is the guidelines.

1. When to code history of and Metastatic
Hi - Can someone clear this question up for me. When do you consider the patient's cancer a history of. My problem is that I am having an issue as to when a patient had a cancer and then that cancer metastasizes. For example - Patient had breast cancer and was treated with RT and Chemo, now several months later the patient has been diagnosed with Bone Mets. I think we should code Bone Mets as primary and then history of breast as secondary. My provider and nurses think we should still be able to code breast cancer 174.x.
ANSWER: Look at the ICD-10 coding guidelines for Chapter 2: Neoplasms (d)

Basically it states that if there is no current treatment directed to the primary malignancy site, then code from category Z85, Personal history of malignant neoplasm.
The secondary site may be the principal diagnosis and the history of; would be the secondary diagnosis.

I would look at the ICD 10 book. Section 2 is on neoplasms. Section M might be something to think about. It's further down than coding history of in the guidelines but may apply.
 

donniruth

Contributor
Messages
18
Location
Lynchburg, VA
Best answers
0
I'm reading Chapter 2 Neoplasm, Section M - there are conditions to being a History of cancer:
- has been previously excised or eradicated from its site
 

donniruth

Contributor
Messages
18
Location
Lynchburg, VA
Best answers
0
I'm reading in Chapter 2, Section M. There are conditions for "history of" cancers:
- has been previously excised or eradicated from its site
- no further treatment of primary malignancy directed to that site
-no evidence of any existing primary malignancy

If these are met, it is history of Z85 - to indicate the former site of the malignancy.

I'm being told that even though the patient had her kidney removed 4 years ago, no further treatment, and then in 2016 - she was diagnosed with mets to the lungs and breast.
I've been coding C78.01 (lung), C79.81 (breast), and history of Renal cancer (Z85)...

I am being told that I should be coding it as: C64.2 (active kidney cancer) as the patient is being treated for "metastatic renal cancer".

I disagree with this - if you look at the original note, I showed excerpts from previous AAPC threads. It was requested that I ask for a more current thread. am I wrong? has this changed? our treatment is directed at the metastatic cancer in the lungs and in the breast.

Please give me some input that would either correct my thinking or support it.
 

mitchellde

True Blue
Messages
13,537
Location
Columbia, MO
Best answers
2
When you code he metastatic site with the history of the primary you are stating that that cancer is still active just no longer active role n the primary site. You should not have any problems with this and it is correct coding. You may just need to explain it in a different light.
 

npricercm

Guest
Messages
282
Best answers
0
When you code he metastatic site with the history of the primary you are stating that that cancer is still active just no longer active role n the primary site. You should not have any problems with this and it is correct coding. You may just need to explain it in a different light.

There is an AHIMA coding clinic that might be helpful...
http://campus.ahima.org/audio/2009/RB111909.pdf - see slides 43 & 44.

There is also a blog entry on AAPC that addresses this...

 

mitchellde

True Blue
Messages
13,537
Location
Columbia, MO
Best answers
2
That section of the coding clinic presentation is stating to use the active breast cancer code because the Herceptin is treating the active cancer.
 
Top