Oncology & Hematology Coding Alert

Question: Which diagnosis codes prove medical necessity for amifostine for a lip cancer patient with radiation-induced xerostomia?

New York Subscriber
 
Answer: Check your specific payers to be sure of their rules, but in general, reporting diagnosis codes for the radiation and the neoplasm should be adequate.

Example: HealthNow's amifostine policy for upstate New York instructs providers to report a treatment encounter code as a primary diagnosis and a neoplasm code as a secondary diagnosis for patients with moderate to severe xerostomia who are undergoing postoperative head and neck cancer treatment.

For the situation you describe, assuming this is postoperative radiation, you would report V58.0 (Encounter for other and unspecified procedures and aftercare; radiotherapy) and the appropriate lip neoplasm code (140.x, Malignant neoplasm of lip).

Other coding possibilities your payer may request include the following:

- V58.11 -- Encounter for antineoplastic chemotherapy

- 527.7 -- Disturbance of salivary secretion (xerostomia)

- 909.2 -- Late effect of radiation

- 909.5 -- Late effect of adverse effect of drug, medical, or biological substance. You should report the neoplasm as the secondary diagnosis.

The condition: Radiation therapy may damage salivary glands and cause dry mouth (xerostomia) in head and neck cancer patients. Amifostine helps protect normal salivary gland cells from the radiation's effects.

Payers may consider amifostine medically necessary when the radiation port includes a large portion of the parotid glands. The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.