Q: For a patient with a history of breast cancer, who is taking tamoxifen, do we code this as a current cancer or use the “history of” Z code?
A: Tamoxifen, while often used to treat early-stage disease, after treatment, to prevent recurrence or a new cancer in the unaffected breast, seeing tamoxifen on a patient’s meds list is NOT always an indication of a “history of” breast cancer. Some patients take tamoxifen prophylactically, or to prevent breast cancer, in cases where the patient has a family history of the disease or a familial mutated BRCA gene. It may also be used to treat advanced-stage metastatic disease to help slow the disease progression. Be sure to review the physician documentation to confirm the patient is disease free before accurately coding a “history of” breast cancer.
Q: With the new guideline about history codes being used as secondary codes, how should we code outpatient cases when the only available diagnosis is the history of cancer?
A: For FY 2022, ICD-10-CM guideline I.C.19.c.4. included new text stating that the reason for the encounter (e.g., screening, counseling) should be sequenced first followed by the appropriate personal and/or family history codes. The primary code should reflect the reason for the encounter. For example, if the patient is undergoing surveillance tests for the history of cancer, which was previously eradicated, assign code Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm. If the patient is presenting for a screening examination for a family history of cancer, assign the screening code first followed by the family history code.
Q: In the webinar, you mentioned resequencing procedures. The encoder automatically sequences procedures and we’ve never reordered them. Should we?
A: Yes, many encoders will auto-sequence the ICD-10-PCS procedure that drives DRG reimbursement into a surgical paying DRG, however the ICD-10-PCS Official Guidelines for Coding and Reporting, section F, give instructions for assigning the principal procedure. If there is another procedure that impacts MS-DRG assignment, list that code second. The sequencing of procedure codes, unlike diagnosis codes, does not impact DRG assignment.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.