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Old 09-14-2009, 03:32 PM
rvalente rvalente is offline
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Default Coding "history of" as current

Hello Fellow coders,
the company I currently work for instructs us to code the following statement; "history of pulmonary embolism" as current if the patient is on coumadin. With the thought that if the patient is taken off coumadin the emboli would return. They also use this method for breast cancer if the patient is still on tamoxifin, AFIB and other HCC codes.

I'm curious as to how your company handles these coding scenerios and wondered if anyone could weigh in with their thoughts.

Thank you
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Old 09-14-2009, 03:40 PM
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Originally Posted by rvalente View Post
Hello Fellow coders,
the company I currently work for instructs us to code the following statement; "history of pulmonary embolism" as current if the patient is on coumadin. With the thought that if the patient is taken off coumadin the emboli would return. They also use this method for breast cancer if the patient is still on tamoxifin, AFIB and other HCC codes.

I'm curious as to how your company handles these coding scenerios and wondered if anyone could weigh in with their thoughts.

Thank you
I would like to say that "I know that we do it the correct way", but I can't. We code it as current due to the patients being on medication for it. I don't know if I have helped or not.
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Old 09-14-2009, 04:00 PM
rvalente rvalente is offline
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I would like to say that "I know that we do it the correct way", but I can't. We code it as current due to the patients being on medication for it. I don't know if I have helped or not.
We also code anthing and everything as current if they are on meds for it. I have no official guidelines on this though and just wondered what others are doing. Thank you for your post
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Old 09-16-2009, 07:41 AM
nc_coder nc_coder is offline
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This happens to be a hot topic in our office right now as well. Quoting the ICD9 guidelines for "history of" codes (found on page 16 of the 2009 Ingenix Expert ICD9):
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. The exceptions to this rule are V14, personal history of allergy to medincinal agents, and V15.0 Allergey, other than to medicinal agents.

From this information- in my opinion- if the patient is still receiving medication from your physician, that is treatment and would remain as current until they are done taking the medication.
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Old 09-16-2009, 08:07 AM
LLovett LLovett is offline
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I have to disagree with coding the PE as current. I have no idea what our coumadin clinic is doing, I will be double checking that (they are not technically mine but I am involved on certain issues).

At the beginning of the Tabular section of the V codes there is an explanation when these codes should be used. I think this scenario falls under b.

"b) When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change"

Just my take on it,

Laura, CPC, CEMC
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Old 09-16-2009, 09:32 AM
HavaTwo HavaTwo is offline
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We use V codes for a lot of the patients in our Coumadin Clinic, as it depends on what the medication is being used for. Coumadin and tamoxifin are both drugs to treat OR prevent. If the PE or breast cancer are still present, the medication is being used to treat; if there is a history of PE or breast cancer, the medication is being used to prevent a recurrence.
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Old 09-16-2009, 02:27 PM
nc_coder nc_coder is offline
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Thank you for that description MMaine. That is exactly what I have been trying to explain to one of my physicians but couldn't get the right description to come out. He says that if he is performing "on going oncological care" of a patient that the surgery was done to remove a malignancy and it could possibly recurr, then we should be coding as the malignancy and not history of. I disagree. If the cancer was removed, the patient doesn't have it anymore and therefore should not be coded that way.
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Old 09-20-2009, 07:33 PM
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Thank you for that description MMaine. That is exactly what I have been trying to explain to one of my physicians but couldn't get the right description to come out. He says that if he is performing "on going oncological care" of a patient that the surgery was done to remove a malignancy and it could possibly recurr, then we should be coding as the malignancy and not history of. I disagree. If the cancer was removed, the patient doesn't have it anymore and therefore should not be coded that way.
Not entirely true with malignancy, just because the tumor is removed does not mean the malignancy is gone, the reason the patient is treated on going with radiation and chemo is to destroy malignant cells that are still present, so the malignancy is still ongoing, whereas if you take the care of the PE, it is hx of and the coumadin is not treating an acute status, it is prophylactic treatment to prevent the recurrence, so the PE is hx of and to code it as current is incorrect and not what the physician documented.
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