Diagnosis coding for a malignant neoplasm is generally straightforward, but there are a few issues that may cause confusion.
According to the ICD-9-CM Official Guidelines For Coding and Reportingpublished by the American Hospital Association (AHA):
“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 V10, 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 V10 code used as a secondary code.”
While the guidelines for tumor registry reporting may require that the patient be listed with a malignancy for a specified time period (i.e., six months, five years, etc.), the guideline for ‘history of’ a malignancy listed above applies for the submission of insurance claims. As a result, if a patient with ductal carcinoma in situ has had the malignancy surgically excised, has completed radiation and/or chemotherapy and is currently on a regimen to prevent further malignancies, this patient would be assigned the diagnosis code for ‘history of’ breast cancer (V10.3) as soon as the treatment is concluded.
This is key when a patient is treated for a primary malignancy, and treatment continues for metastatic disease. In addition, metastatic cancer can be treated in one location, such as the bone, and continued in a second location, such as the brain. In both of these scenarios, it is key to assign the code for the area under treatment, and not the diagnosis for the primary malignancy.
The complete text of the Official Guidelines is located at: http://www.cdc.gov/nchs/data/icd9/icdguide.pdf
Cindy C. Parman, CPC, CPC-H
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association. She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.