Herceptin. What is it? What is it used to treat? And how should a coding professional code for this when documented? This edition of “In the kNOW” will provide answers to these questions.
Herceptin is a type of treatment for breast cancer. It is not a form of chemotherapy or immunotherapy. Rather, it is categorized as a targeted form of therapy. It is a monoclonal antibody specifically designed to treat HER2+ (Human Epidermal growth factor Receptor 2-positive) breast cancer by becoming attached to the HER2 receptors on cancer cells. The presence of Herceptin in those receptors acts as a blocking agent for growth signals to the cell. Thus, the growth of the cancer cells can be inhibited or stopped altogether. In addition to slowing the growth of cancer, Herceptin can act to prevent recurrence in the same manner.
Source: https://www.herceptin.com/patient/breast-cancer.html
Herceptin is administered via an IV infusion over 30-90 minutes per weekly session. Depending on the stage of cancer being treated, early vs. metastatic, the period of time that Herceptin will be given varies. With early-stage cancer, the treatment may go on for a year, whereas in metastatic cancer cases, the treatment may continue for many years.
A Coding Clinic from the Third Quarter of 2009 directed coding professionals in the correct manner to code when a patient is on Herceptin. Consider this scenario; a patient had a history of RUOQ breast cancer, and had undergone both mastectomy and chemotherapy. At the present time, the patient has no evidence of cancer (not by exam, by histology, or by radiological exam) but is taking Herceptin. Coding Clinic points out that while Herceptin is not chemotherapy, it is a form of cancer treatment. Therefore, they indicate that the cancer code should be assigned first (C50.411 in this case for the right upper-outer quadrant breast cancer) followed by a code for the long-term use of medication (Z79.899 since there is no specific long-term medication code for Herceptin).
The long and short of the Coding Clinic response is that since the cancer is still undergoing treatment, the coding for the use of Herceptin should be the same as if the patient was undergoing chemo or radiation: code the condition as if it still exists.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
