Wiki Chemo Drug billing

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lkiser2

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I am new to oncology coding and need some clarification. I am following Coding guideline regarding ICD-9 coding for encounters for chemo/immuno therapy. Guidelines state to bill V58.11 or V58.12 as primary when a patient comes in for chemo or immuno therapy and list the cancer code secondary. I am being told that the practice billed the V code as secondary because payers will not pay the claim if the V code is listed as primary.

Which is the correct billing practice? I think I should be following the ICD guidelines. Please help.

Lee Ann
 
The ICD guidelines are HIPAA mandated to be followed. Look at page one of the guidelines third paragraph down. The V58.11 and V58.12 codes are only allowed first listed and are not valid as secondary codes. Honestly claims should deny if these codes are used as anything but first listed. If your drugs are not chemo or immunotherapy classified, such as BRM drugs then you do not use these V codes at all, you use the neoplasm code first listed.
 
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The OGCR classify codes V58.11 and V58.12 as Primary, however, most payers require the malignancy code primary and the chemo or immunotherapy code secondary both linked to the procedure codes. Payer preference needs to be considered, this is not black and white. It is long standing issue and Oncology/Hematology coders are used to this.
 
Chemo Drug Billing

I'm billing for Chemotherapy infusion. Patient has a diagnosis of SLE (systemic lupus erythematosus) icd-9 code 710.0. Can that be the only icd code i should be using for her chemotherapy infusion? Since it's not considered immunotherapy for neoplastic condition (V58.12)?
 
lizardw5 said:
The OGCR classify codes V58.11 and V58.12 as Primary, however, most payers require the malignancy code primary and the chemo or immunotherapy code secondary both linked to the procedure codes. Payer preference needs to be considered, this is not black and white. It is long standing issue and Oncology/Hematology coders are used to this.
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I disagree, payer preference cannot go over the coding guidelines. As a HIPAA payer and provider all HIPAA rules and regs must be followed. As I stated the coding guidelines are HIPAA mandated to be followed. A payer cannot tell a provider how to bill a claim or which code should be listed first. I have been a Hem/onc coder for many years and have never had any issues listing the V codes first for chemo or immunotherapy.
 
Chemo Drug Billing

What if the chemo is held at that office visit, but the patient is still in the middle of a series of chemo therpy? Would you code V58.11/V58.12 as secondary to show the patient is still receiving chemo just not at that visit or would you not code anything. A coworker also suggested using V58.69 to show the patient is receiving chemo, but not at that visit. Any feedback would be great.
 
If they are not receiving chemo at that visit and the Cancer is still active then code only the Cancer code. I have never used the V58.69 to indicate a patient is on chemo. If there is a documented reason the chemo is being held, then use that code first listed.
 
JS81coder said:
Chemo Drug Billing
What if the chemo is held at that office visit, but the patient is still in the middle of a series of chemo therpy? Would you code V58.11/V58.12 as secondary to show the patient is still receiving chemo just not at that visit or would you not code anything. A coworker also suggested using V58.69 to show the patient is receiving chemo, but not at that visit. Any feedback would be great.
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