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Diagnosis Breast Cancer vs Hx. Code

Mercy Posted Thu 21st of April, 2011 13:37:27 PM

Hi,
If a patient is put on Faslodex for history of breast cancer. What diagnosis should I put on this claim. Hx. of breast cancer V10.3 or current cancer of 174.9

Thank you,
Marci

SuperCoder Answered Thu 21st of April, 2011 14:58:51 PM

As the patient is taking medication presently for history of ca, it indicates that patient is still in cancer and for that patient is taking Faslodex, so I would go for 174.9 rather than V10.3.

Renee Answered Fri 22nd of April, 2011 21:37:36 PM

This is from the coding guidelines 2008

There is a new subcategory for prophylactic use of agents affecting estrogen receptors and estrogen levels, V07.5, with three new codes: V07.51, Prophylactic use of selective estrogen receptor modulators (SERMs); V07.52, Prophylactic use of aromatase Inhibitors; and V07.59, Prophylactic use of other agents affecting estrogen receptors and estrogen levels. Assign the appropriate code from subcategory V07.5, Prophylactic use of agents affecting estrogen receptors and estrogen levels, for patients receiving a drug that affects estrogen receptors or estrogen levels (such as tamoxifen) for prevention of cancer. Agents affecting estrogen receptors or levels may be administered prophylactically for patients with a personal history of cancer in order to prevent future recurrence or for patients who have risk factors for developing a particular type of cancer, such as a family history or genetic susceptibility for breast cancer. Codes from subcategory V07.5 should only be assigned if the drug is being administered prophylactically. They should not be assigned if the drug is being given as part of current cancer treatment. In this case, the current cancer and code V58.69, Long-term (current) use of other medications, should be assigned instead of a code from subcategory V07.5.

Codes from subcategory V07.5 may only be assigned as an additional diagnosis. If the reason for the encounter is to initiate therapy involving the use of an agent affecting estrogen receptors or levels for a patient with a previous history of cancer or at high risk for cancer, assign V65.49, Other specified counseling, as the first listed diagnosis and assign the appropriate code from subcategory V07.5 as an additional diagnosis. Additional diagnosis codes should also be assigned for any person or family history of cancer or genetic susceptibility.

If the patient has already started taking the agent affecting estrogen receptors or levels and the reason for the encounter is a follow-up visit to monitor the effects of the drug, assign code V58.83, Encounter for therapeutic drug monitoring, as the first-listed diagnosis and the appropriate code from subcategory V07.5 as an additional diagnosis.

When a patient with a personal history of cancer who is receiving an agent affecting estrogen receptors or levels to prevent recurrence is seen for a follow-up visit (and the visit is not for therapeutic drug monitoring), assign the appropriate code from category V67 as the first listed diagnosis and a code from subcategory V07.5 as an additional diagnosis. The appropriate personal history of cancer code should be assigned as an additional diagnosis.

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