Oncology & Hematology Coding Alert

Question: One of our physicians recently treated a trachea cancer patient with chemotherapy infusion for 1 hour and 55 minutes. Is the V58.1 (Chemotherapy) code enough to prove medical necessity for the chemo session?

Arkansas Subscriber
 
Answer: The V58.1 code should prove medical necessity on the claim, but the V code should be accompanied by another diagnosis code that describes the cancer the oncologist is treating. Otherwise, your claim may not be acceptable to the payer.

Don't rely on a V code alone; on your claim, you should:

report 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) for the first hour of the chemo infusion

report +96412 (... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure]) for the remaining infusion time

report ICD-9 code 162.0 (Malignant neoplasm of trachea, bronchus, and lung; trachea) with 96410 and 96412 as the secondary diagnosis code, unless payer
guidelines instruct otherwise

report V58.1 with 96410 and 96412 as the primary diagnosis code, based on the official AHA guidelines. General Guidelines: According to the ICD-9 manual, oncology practices should employ V codes when:

a person not currently sick avails himself of your office's services (for prophylactic vaccinations, as organ/tissue donors, etc.)

a person who already has a known disease or injury avails herself of your office's services for treatment of that specific disease.

a person avails himself of your office's services for a problem that affects his health but is not necessarily an illness or injury.