Merck Manual Hematologic/Oncology
National Alliance Breast Cancer
Neoplasm Featured Article LaGuna Med
Cancer vs. History of Cancer: When to Change the
DiagnosisQuestion: When should a cancer diagnosis be replaced with a “history
of cancer” diagnosis code? If the patient had a resection for sigmoid colon
cancer two years ago and requires surveillance scopes on occasion, which
diagnosis code should be used for those scopes?New York Subscriber
Answer: Although cancer registries typically expect five
years to elapse before a diagnosis of cancer is removed, that does not apply to
physician ICD-9 coding.
If the patient is cancer-free, a personal history of cancer
diagnosis should be used for any procedure subsequently reported (typically,
once the global period of the procedure that removed the cancer has ended). The
American Hospital Association's coding clinic guidelines state that “history
of cancer” diagnoses should be used once the tumor has been removed, treatment
has ended and there is no evidence of recurrence.For example, a patient who
underwent a sigmoid resection (44140, Colectomy, partial; with anastomosis)
returns to the surgeon for surveillance endoscopy — either 45330 (Sigmoidoscopy,
flexible; diagnostic, with or without collection of specimen[s] by brushing or
washing [separate procedure]) or 45378 (Colonoscopy, flexible, proximal to
splenic flexure; diagnostic, with or without collection of specimen[s] by
brushing or washing, with or without colon decompression [separate procedure])
— to determine if the margins remain cancer-free. Code V10.05 (Personal
history of malignant neoplasm; large intestine) should be used in this case,
rather than 153.3 (Malignant neoplasm; sigmoid colon) or any other malignant
neoplasm code.If the patient had a sigmoid cancer resection and the margins
remained clear but the mesenteric lymph nodes were positive, report the pretest
diagnosis as personal history of colon cancer, and the post-test diagnosis as
the lymphatic malignancy (196.2, Secondary and unspecified malignant neoplasm of
intra-abdominal lymph nodes). If the patient receives chemotherapy, use 196.2
for the primary diagnosis and V10.05 as the secondary diagnosis.
When should dx of Cancer change to history of Cancer?