Wiki Admin. of Neulasta, not for Chemo purposes - Z51.11 or Z51.12 or neither???

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We are getting denials for myeloid growth factor injections, particularly Neulasta. I don't code these encounters with Z51.11 as the patient did NOT receive their chemo drug.
I have spoke with someone to see if this would be considered an encounter for immunotherapy, since it's not the patient's chemotherapy regimen, and it is a myeloid growth factor. Z51.12 also meets medical necessity for Neulasta. I am not exactly comfortable with the response they gave me, so I am hoping someone can help. I am still kind of new to coding for oncology.
Their response was that since the Neulasta is RELATED to the chemotherapy then Z51.11 is the CORRECT code to use.
Thoughts? How does everyone else code this when the patient is there for an injection like Neulasta???
Thanks!
 
The cancer codes....and if they are there for chemo I would use Z51.11 - and that actually covers medical necessity, but if the patient is not receiving chemo, I use the cancer codes only, as that is all I have to go by is their treatment plan
 
We are getting denials for myeloid growth factor injections, particularly Neulasta. I don't code these encounters with Z51.11 as the patient did NOT receive their chemo drug.
I have spoke with someone to see if this would be considered an encounter for immunotherapy, since it's not the patient's chemotherapy regimen, and it is a myeloid growth factor. Z51.12 also meets medical necessity for Neulasta. I am not exactly comfortable with the response they gave me, so I am hoping someone can help. I am still kind of new to coding for oncology.
Their response was that since the Neulasta is RELATED to the chemotherapy then Z51.11 is the CORRECT code to use.
Thoughts? How does everyone else code this when the patient is there for an injection like Neulasta???
Thanks!
Why is the physician is giving the Neulasta injection? Is it an adverse effect to chemo?
When this happens we code the proper E/M code, and the diagnosis is the adverse effect .
 
They are not giving an adverse effect. All I have to go by is the patient's treatment plan. They say it is part of the chemotherapy regimen, but it is not actual chemo. It seems like they are giving it bc the patient is receiving chemo.
 
We are getting denials for myeloid growth factor injections, particularly Neulasta. I don't code these encounters with Z51.11 as the patient did NOT receive their chemo drug.
I have spoke with someone to see if this would be considered an encounter for immunotherapy, since it's not the patient's chemotherapy regimen, and it is a myeloid growth factor. Z51.12 also meets medical necessity for Neulasta. I am not exactly comfortable with the response they gave me, so I am hoping someone can help. I am still kind of new to coding for oncology.
Their response was that since the Neulasta is RELATED to the chemotherapy then Z51.11 is the CORRECT code to use.
Thoughts? How does everyone else code this when the patient is there for an injection like Neulasta???
Thanks!
I would use one of the following dx codes: 1. D70.9 Neutropenia, unspecified 2. T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs initial encounter. Neulasta is administered to patient's undergoing chemotherapy, when their WBC drops, due to chemo treatment. So both these dx codes are correct, because the crashing of the immune system IS an adverse effect of chemotherapy and alternatively, since the condition that is a result of the chemo treatment is neutropenia, you should be able to use that dx as well.
 
Yes you do need a code for the adverse effect and the neutropenia, however you will not be able to code these without the provider documenting these conditions. Without the documentation of the the neutropenia you can only use the dx code for the cancer , not the z code for chemo admin, Unless it is being given. You do have instances where the provider will order the admin of neulasta prophylactic to prevent the adverse reaction. Some payers will not pay for that.
 
I would use one of the following dx codes: 1. D70.9 Neutropenia, unspecified 2. T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs initial encounter. Neulasta is administered to patient's undergoing chemotherapy, when their WBC drops, due to chemo treatment. So both these dx codes are correct, because the crashing of the immune system IS an adverse effect of chemotherapy and alternatively, since the condition that is a result of the chemo treatment is neutropenia, you should be able to use that dx as well.
I spoke with someone from the office, and they said this is just given to prevent neutropenia.
 
I would use one of the following dx codes: 1. D70.9 Neutropenia, unspecified 2. T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs initial encounter. Neulasta is administered to patient's undergoing chemotherapy, when their WBC drops, due to chemo treatment. So both these dx codes are correct, because the crashing of the immune system IS an adverse effect of chemotherapy and alternatively, since the condition that is a result of the chemo treatment is neutropenia, you should be able to use that dx as well.
She also said this was definitely not an adverse reaction. Their office is actually billing with Z51.11 when they are not getting chemotherapy.
 
Yes you do need a code for the adverse effect and the neutropenia, however you will not be able to code these without the provider documenting these conditions. Without the documentation of the the neutropenia you can only use the dx code for the cancer , not the z code for chemo admin, Unless it is being given. You do have instances where the provider will order the admin of neulasta prophylactic to prevent the adverse reaction. Some payers will not pay for that.
Right, and there is no documentation to support this. All of their patients get this prophylactically to prevent neutropenia. She also said it was not an adverse reaction, it was definitely just used to prevent neutropenia. Their office is actually billing for the neulasta and other myeloid growth factors with Z51.11 even when they are not receiving their chemo. I code for the hospital side of it. I tried to explain that I didn't feel Z51.11 was correct, but she said they have always done this and never had any issues, which they wouldn't as far as medical necessity is concerned because Z51.11 is listed as a covered diagnosis, but I didn't feel it was accurate coding.
 
I agree you cannot use z51.11 if no chemo is being administered that day. However look at Z29.8 for other prophylactic measures. I would use this code with the neoplasm code since that is the reason for the injection. You cannot use a code for neutropenia since the patient does not have it, nor has there been an adverse reaction yet. My biggest pet peeve is when coders use a dx code just to get paid. I applaud you for doing the leg work to find a better solution.
 
Yes you do need a code for the adverse effect and the neutropenia, however you will not be able to code these without the provider documenting these conditions. Without the documentation of the the neutropenia you can only use the dx code for the cancer , not the z code for chemo admin, Unless it is being given. You do have instances where the provider will order the admin of neulasta prophylactic to prevent the adverse reaction. Some payers will not pay for that.
I agree
 
I agree you cannot use z51.11 if no chemo is being administered that day. However look at Z29.8 for other prophylactic measures. I would use this code with the neoplasm code since that is the reason for the injection. You cannot use a code for neutropenia since the patient does not have it, nor has there been an adverse reaction yet. My biggest pet peeve is when coders use a dx code just to get paid. I applaud you for doing the leg work to find a better solution.
She also said this was definitely not an adverse reaction. Their office is actually billing with Z51.11 when they are not getting chemotherapy.
Ok, I read your other messages and I see now that the patient does not have neutropenia. Well, I agree with mitchellde, it seems like Z29.8 with the neoplasm code would be the most appropriate in this scenario. If they have been billing Z51.11 and have been getting paid, that does not make it right. Neulasta is an extremely expensive drug and if they are administering that regularly as a preventive measure, then it should be coded as such and if some payers don't pay, they're justified in not paying and that does not mean one should use a dx that will get it paid. This is just my opinion. In any case, Z51.11 is definitely incorrect and you should not use it.
 
I agree you cannot use z51.11 if no chemo is being administered that day. However look at Z29.8 for other prophylactic measures. I would use this code with the neoplasm code since that is the reason for the injection. You cannot use a code for neutropenia since the patient does not have it, nor has there been an adverse reaction yet. My biggest pet peeve is when coders use a dx code just to get paid. I applaud you for doing the leg work to find a better solution.
I agree, and thank you!! They are still saying the correct way to bill is Z51.11, but I can't find anything to support this if the patient is not receiving chemo.
I will look at this code. Thanks!
 
Ok, I read your other messages and I see now that the patient does not have neutropenia. Well, I agree with mitchellde, it seems like Z29.8 with the neoplasm code would be the most appropriate in this scenario. If they have been billing Z51.11 and have been getting paid, that does not make it right. Neulasta is an extremely expensive drug and if they are administering that regularly as a preventive measure, then it should be coded as such and if some payers don't pay, they're justified in not paying and that does not mean one should use a dx that will get it paid. This is just my opinion. In any case, Z51.11 is definitely incorrect and you should not use it.
Yes, I actually spoke with someone and they said it is done for prophylactic purposes. There are some cases where the patient develops neutropenia or pancytopenia and then there are not issues. However, it is not always the case, especially when the patient has just started receiving chemotherapy.
Yes, Neulasta is a very expensive drug, and it appears they have just been sticking this code on to get paid, but I can't say for sure. All I know is they do NOT have medical documentation to support using Z51.11 on the days the patient is not receiving chemo and only receiving the myeloid growth factor injections. I spoke to someone again yesterday and she said their coders/billers have always used Z51.11 and that is does NOT have to be on the day the patient receives chemo, and they have never had any issues.
I will see about adding the Z29.8. It will definitely help clarify the reason for injection and encounter, but it will not cover medical necessity for medicare.
 
Yes it can be given prophylactically based on the chemotherapy regimen. Z51.11 is not appropriate. We have patients who receive no chemo and receive Neulasta or another GCSF. Z29.8 as well as neoplasm and Z79.899 (to indicate that patient is currently receiving chemotherapy) would be the appropriate coding.

However for medical necessity purposes, the chemotherapy plan should be either high or intermediate risk for neutropenia based on NCCN guidelines. Otherwise the Neulasta would need to be given in the event of febrile neutropenia.
 
Our facility uses Z51.89 for Neulasta when it is not being given for neutropenia. Normally, the physicians will order it after a cycle of chemotherapy. Read the guideline in Chapter 21 of the ICD10 coding book under "Aftercare". I would consider it continued care during the recovery phase after a chemo cycle.
 
Our facility uses Z51.89 for Neulasta when it is not being given for neutropenia. Normally, the physicians will order it after a cycle of chemotherapy. Read the guideline in Chapter 21 of the ICD10 coding book under "Aftercare". I would consider it continued care during the recovery phase after a chemo cycle.
I have spoke with them about this code as well. They are saying this is not appropriate either. They are standing by using Z51.11. I don't know what else I can do...
 
Our facility uses Z51.89 for Neulasta when it is not being given for neutropenia. Normally, the physicians will order it after a cycle of chemotherapy. Read the guideline in Chapter 21 of the ICD10 coding book under "Aftercare". I would consider it continued care during the recovery phase after a chemo cycle.
But it's not part of typical aftercare on all chemotherapy. It's a prophylactic treatment to avoid febrile neutropenia.
 
Yes it can be given prophylactically based on the chemotherapy regimen. Z51.11 is not appropriate. We have patients who receive no chemo and receive Neulasta or another GCSF. Z29.8 as well as neoplasm and Z79.899 (to indicate that patient is currently receiving chemotherapy) would be the appropriate coding.

However for medical necessity purposes, the chemotherapy plan should be either high or intermediate risk for neutropenia based on NCCN guidelines. Otherwise the Neulasta would need to be given in the event of febrile neutropenia.
How does your facility code/bill for patients who are receiving growth factors for prevention of febrile neutropenia? They just sent me this massive email today arguing that I am to be using Z51.11 for these encounters, and that it is accepted and payable and covered through Medicare. I am not comfortable using Z51.11 when the patient is not actually receiving chemo or immunotherapy that day. If this is acceptable and there is some information available please let me know. It has been my understanding that Z51.11 is not correct or accurate coding when the patient is not receiving chemo.
Thanks in advance!
 
I suggest you write to AHA coding clinics as they will give a ruling that your higher ups will pay attention to. You will need to append the directive sent to you instructing that it be coded as chemo.
 
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