Question: 20190107

Status


Final

Category


#1:   First course treatment
#2:   Chemotherapy
#3:   Colon


References


Source 1:  
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Notes:  
Source 2:  
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Question


First Course Treatment/Chemotherapy--Colon:  Is maintenance therapy coded as part of the first course of treatment or as part of subsequent course of treatment?



Discussion


Patient was diagnosed with Stage IV colon cancer (liver metstasiss) and started on Folfox with Avastin.  The medical oncologist decided to continue maintenance treatment with Xeloda and Avastin.

Per Colon NCCN Guidelines Version 3.2019, interest in the use of maintenance therapy approach after first-line treatment of unresectable, metastatic colorectal cancer is growing. In general, this approach involves intensive first-line therapy, followed by less intensive therapy until progression in patients with good response to initial treatment.

Colon Therapy

5/1/18 Colonoscopy biopsy: mod diff colon adenoca, MMR proficient, BRAF wild type

5/5/18 Liver biopsy: mets from colon cancer

6/18/18 – 11/20/2018 Med Onc: started 12 cycles Chemo - Folfox (Fluorouracil, leucovorin, Oxaliplatin) with Avastin

11/28/18 CT Pelvis: continued improvement in the liver mets; no residual tumor involving colon; no new mas or adenopathy in the chest, abdomen or pelvis

12/02/18 Med Onc follow up: Pt had tremendous response to chemotherapy and Avastin, cancer is not curable. Is amenable to maintenance therapy with Xeloda and Avastin; also amenable to descending colectomy in the future

1/7/19 Med Onc: starting maintenance treatment Xeloda + Avastin.



Answer


Code the maintenance therapy as first course when the maintenance therapy includes at least one of the drugs from the original treatment. Use text fields to record the details.



History




Last Updated


12/23/2019

Date Finalized


01/17/2020