tci General Surgery Coding Alert - 2011 Issue 3

You Be the Coder: 153.3 Vs. V10.05 May Not be Clear

Question: Our surgeon placed a Medi-port for chemotherapy four months ago for a patient who had a colon resection for malignancy over six months ago. The patient has completed the course of treatment and is back in the office for the surgeon to inspect the incisions (resection and Medi-port) and to discuss when to schedule the Medi-port removal. The surgeon dictates the reason for the visit as "present colon cancer". Because the colon cancer treatment is complete, shouldn't the diagnosis be "history of colon cancer"?Answer: If all the treatment directed toward the primary cancer is complete, you are...

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