Reimbursement Advisor

5-month follow-up after cancer resection

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Q Five months after surgery to remove endometrial cancer, a patient came in for a follow-up visit. Since the 90-day follow-up period had passed, we billed for an office visit. The diagnostic codes used were V10.42 (personal history of endometrial cancer) and V76.2 (special screening for malignant neoplasms, cervix) for Pap screening. Because ICD-9 marks V10.42 as a secondary diagnosis, however, I fear this may be incorrect. Is it?

A Before answering this question, we need to better define the situation by making some assumptions. First, I will assume that the surgery involved removing the uterus as well as the cervix.

Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.

And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.

I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.

Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.

If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.

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