Billing with V58.11Encounter for antineoplastic chemotherapy

MLambert1565

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I am enrolled in the CPC Preparation Course. I have seen a couple times a diagnosis code that I have a question about.
The code is V58.11. I work in an Hematology/Oncology office where we give chemotherapy treatments. I have only been in this field for 11 months, so I questioned my co-worker about this. She has been with this practice for 6 years. She stated they tried using the V codes before, for chemo visits only, in the past and carriers would reject the claims. Can anyone put some clarification on this issue and how it may affect reimbursements, if used vs. not used.

Thank you for any insight, you can provide.
Michelle
 

ptrautner

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if the patient is presenting for chemo treatment that would be their principle diagnosis followed by the cancer diagnosis or complication. there is always some payors that are a little funky with their diagnosis requirements but that is the correct way to do it.

soon to be a CHONC
 

mitchellde

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You must follow the guidelines for diagnosis coding which state to use the V58.11 for Chemo. It is first listed only allowed then you follow with the Cancer dx code. You need to explore the reason for the denials. The rules for dx coding are set by the CDC and are mandated thru HIPAA for adherence. If the patient were not receiving chemo drugs though then you would not use the V58.11. If the were receiving immunotherapy then use the V58.xx code for immunotherapy, If they were receiving BRM therapy then you would not use a V58.xx code you would code the neoplasm first listed. It is important to know what kind of drug you are giving to know if the code is correct.
 
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Correct! Follow the coding guidelines as we were asked to change the sequence because a payer's system couldn't read all the dx fields of the UB.... My response to that payer was update your system as we will continue to follow correct coding guidelines.

V58.11 and V58.12 per coding guidelines must be first code listed along with the appropriate cancer code.
 
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