| Q: | My PCP documented and coded breast cancer (ICD-10-CM code C50.-) for a patient who had a mastectomy three years ago and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-10-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase and generally, the use of Tamoxifen or similar medications is to prevent a recurrence of the cancer. The key to the coding, then, is not the presence of this medication, but the presence of evidence indicating the cancer has returned. Absent any such information, the ICD-10-CM code of C50.- is incorrect in this example. The correct code is Z85.3, Personal history of malignant neoplasm of breast. |
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