Wiki When is cancer consider history of???

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lillianivy

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Can someone please send me to a link or article stating what the exact guidelines are for History of Cancer. If a pt is considered to no longer have breast cancer but is receiving an Anti-Estrogen drug to prevent it from returning, is that considered active or history of? I know some drugs are given as maintenance. And some are given as preventive. How do you know when to change it to History of? Myself and our doctors need clarification. We have had issues of getting claims paid bc we state active cancer bc pt is still taking some drug as "maintenance/prevention" but insurance says it's history of bc previous scans show no cancer. Pt's usually continue certain drugs 5-10 yrs once cancer is gone. HELP!!!!

Thank you,
Lydia
 
And BC is right!! A history code is reported even if the patient is using medication for prevention of reocurrence. The malignant neoplasm should not be coded since there is no active treatment currently for cancer.

When a primary malignancy has been excised but further tratment such radiation or chemotheraoy is directed to the site, the primary malignancy should be coded until treatment is completed

The key for this is to define if the treatment is actively directed to the malignanccy

hope this help!

alhmed morales, CPC
 
can you give any documentation on this?? I have a few questions on when to code as h/o ... such as the above question about aromatase inhibitors and when a person is receiving adjuvant chemotherapy, would this be considered h/o as well??
 
if the drug is being used to "suppress" active cancer cells as in Tamoxifen, then you are still treating the cancer on a long term basis and it is coded as active cancer. Look in the drug book for the drug indication if the indication is for example, breast cancer then you code active breast cancer as the code. Even though there is no other treatment and the provider indicates NED at the primary site, they are still treating active cancer cells to suppress their recurrence.
 
Cancer-NED

Hi. Coders

Can any one please give clarification on the below:

What code is to be coded when the document states:-"A patient had a malignant prostate neoplam excised three years ago and has completed radiation and chemotherapy. Currently there is NED.however the pt is receiving continue treatment for prostate cancer with docutaxel."

Please do send in you response and ides in coding this.
 
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I have a patient who we have been coding as History of Lymphoma. He is NED and no current 'treatment' but he is still being followed by our oncologist for follow-up and monitoring for recurrence.

Here's the problem. A chest x-ray was ordered using the History of Lymphoma code and is being denied by Tricare as not covered for that Dx.

Since he is still being followed for recurrence and has had a service (the chest x-ray) done for monitoring, should this be billed with the active lymphoma dx?

I don't consider a chest x-ray to be 'treatment' but I'm starting to think that some companies might.

Does anyone continue to use the active code until the patients have been completely released by the oncologists?

Any thoughts??

Alanna
 
If you look under the V-code guidelines in the ICD9 book, Chapter 18, under "History of" section, it states: personal history codes may be used in conjunction with follow up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure.

By follow up codes, I believe they are referring to the ICD9 follow up codes listed later in same chapter section 8 under "Follow up"
 
First, no you may not use an active cancer code when there is not treatment being rendered and an x-Ray is not treatment. You do use follow up,codes with history of cancer codes
Second, history of codes are V codes in thenV67 category , there is follow up following chemo , or follow up following radiation which ever was the lat treatment applied,
 
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