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Complications of surgery, uncertain diagnoses, and more highlight important updates for coders

Briefings on Coding Compliance Strategies, November 1, 2009

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This entry is important because it addresses whether a patient receiving adjuvant cancer therapy is considered to have a history of cancer or to actually have cancer when he or she has no overt clinical indicators of such.

The patient in this scenario had a malignant breast neoplasm excised and treated three years ago, currently has no clinical, radiographic, or pathological evidence of a breast neoplasm, and is still receiving treatment with Herceptin, a monoclonal antibody that stimulates the body’s immune system to kill cancer cells. Coding Clinic states that this case should be coded with 174.9 (malignant neoplasm of female breast, unspecified), followed by a V code for the Herceptin maintenance.

Adjuvant therapy is additional cancer treatment, such as chemotherapy, hormonal therapies (e.g., tamoxifen), radiation therapy, or a combination thereof, and is given to lower the risk that the cancer will recur. In essence, Coding Clinic states that if a patient receives an adjuvant treatment (in this case, Herceptin), a coder should report a code for the actual presence of the malignancy, not a V code indicating a history of it.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Coding Compliance Strategies.

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