Wiki History of VS active diagnosis for cancer. Any RAD ONC coders out there?

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1formissy

1formissy

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I have a radiology oncology practice where they are stating in the documentation that there is no evidence of disease. (NED) after treatment is complete. According to AAPC article, when there is no evidence left we would code history of. One of the providers today told me that she was instructed to use the active diagnosis cancer code because they are radiology oncology and a patient with a history of cancer would not be paid because radiology oncology treats patients with cancer. (as everyone knows). I have not heard from any source that this is true so I would like to get some input from any seasoned RAD ONC coders out there.
Any information is most helpful. Thank you!
 
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This is from SGO's 2021 coding question & answers:
How long can you use the cancer diagnosis (C56.1-9) for a patient once they have completed treatment?
Historically the primary cancer codes were used until the patient had been in remission for 5 years. However recent guidelines state that when the primary has been previously excised or eradicated from its site, there is no further treatment directed to that site, and there is no evidence of any existing primary malignancy at that site, it is appropriate to use the personal history code. Both are recognized for patients who are on surveillance. For patients on treatment, including maintenance, the primary cancer code should be used.

So, for patients not receiving any current treatment and NED, it should be history of per current guidelines. Older guidance was to use the active cancer code until remission for 5 years. I do not know when the guidelines changed, but I do know when I started in gynonc about 16 years ago, I recall several seminars being instructed to use active cancer codes until the 5 year mark.
It is possible the provider was told this awhile ago, or the person informing the doc was not aware of the current guidelines.
You should not have any payment difficulties as radonc using history of cancer codes for E/M services.

Hope that helps explain the differing advice!
 
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Christine, thank you very much! This does back up what I had told the providers. Whewww. You are the best and thank you for taking the time to reply to my question. :)
 
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1formissy said:
I have a radiology oncology practice where they are stating in the documentation that there is no evidence of disease. (NED) after treatment is complete. According to AAPC article, when there is no evidence left we would code history of. One of the providers today told me that she was instructed to use the active diagnosis cancer code because they are radiology oncology and a patient with a history of cancer would not be paid because radiology oncology treats patients with cancer. (as everyone knows). I have not heard from any source that this is true so I would like to get some input from any seasoned RAD ONC coders out there.
Any information is most helpful. Thank you!
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I never heard that as well. Per study guide you code to history when there are no further treatments to the cancer. Also if patient is on drug therapy then code active cancer code.
 
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If they're only being seen in follow up after completed treatment, you would code an encounter for follow up and history of. If they're still receiving treatment, even if it's not necessarily radiation, it would be active cancer.
 
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