Published April 2026

Breast cancer care often spans primary care, surgery, medical oncology, and radiation oncology. Members may move between active treatment, surveillance, and long-term endocrine therapy. To support accurate ICD-10-CM coding, please document: current disease status (active vs NED/history); site, laterality, type, stage (when known); whether there is recurrence or metastatic disease; and the intent of ongoing therapy (active treatment vs preventive/maintenance). View the MVP Provider Reference Coding Guide.

Active vs Historical Examples

• Active: active right breast cancer on chemotherapy; receiving radiation for left breast cancer; metastatic bilateral breast cancer on systemic therapy
• Historical: history of right breast cancer s/p lumpectomy with NED after completing treatment; s/p left mastectomy, no evidence of recurrence; bilateral breast cancer in remission
• If uncertain: preventive endocrine therapy for right breast cancer; possible recurrence of left breast cancer pending biopsy

Hormone Therapy: Active vs. Preventive Examples

• Active treatment: metastatic right breast cancer on endocrine therapy; locally advanced left breast cancer on neoadjuvant therapy
• Preventive/maintenance: historical right breast cancer with NED, Tamoxifen for prevention; s/p left mastectomy—no recurrence; endocrine therapy for risk reduction

Radiation Therapy (External Beam or Brachytherapy) Examples

• During radiation course: right breast cancer on active radiation therapy (week 3 of 6)
• After radiation completed: history of left breast cancer, completed radiation with NED

Quick Tips and Codes:

• If your note states “history of breast cancer,” active breast cancer should not be coded, even if the patient remains on endocrine therapy.