Wiki chemotherapy

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Kocur1

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Patient has a hx of breast cancer, she is clear from cancer for 2 years, she comes in for a routine f/u and found that the cancer spread to the lymph node.
How would you code for the chemo treatment do you code use V58.11, 174.9, 196.9 or v58.11, 196.9, V10.3?

thank you.
 
You would code the chemo admin first then the metastatic cancer code then the hx of breast cancer. The primary site is still free of disease, the cells moved to a new organ.
 
Our claims are being paid for without the V58.11 code being used and our insurance carriers would not pay a claim using 196.9/V10.3. We bill using 174.9/196.9.
 
Look at the coding guidelines if the reason for the encounter is chemo then V58.11 is required to be first listed. AHA coding clinics have stated on many occasions that you the cancer being treated next and if it is a metastatic cancer then you always list the primary also, and it can be active, hx of , or unknown. If there is no evidence of disease at the primary site and there is no residual tx being directed to the primary site then it is hx of and MUST be coded that way. We must remember that the dx is the patient's and not the carriers and we have a duty to code it as documented by the physician to acurately capture the patient's condition for data collection. The carrier cannot tell us what the patient's dx is.
 
Is it possible that the drugs being given are not chemotherapy? If so that is fine for instance BRM drugs would not be coded as V58.11. But if the reason for the encouner is for the administration of chemo then you must use the V58.11 code.
 
so if a patient is coming in specifically for the administration of chemotherapy, my first code must be v58.11?
 
mitchellde said:
Is it possible that the drugs being given are not chemotherapy? If so that is fine for instance BRM drugs would not be coded as V58.11. But if the reason for the encouner is for the administration of chemo then you must use the V58.11 code.[/QUOTE

Hi Debra,

I wanted to see if you know where I could get a quick reference to decipher if the drugs listed within the body of the progress notes are for chemo or not? I am having some difficulty deciphering the MDM on my encounters. I am very new to oncology coding and there is alot I need to learn.

Thanks in advance,
Click to expand...
 
history of

Is it just me, or does anyone else have a problem with their providers always using the current dx, when the documentation clearly shows, recurrence at a different site/history of?
 
Per Texas Medicare Guidelines. V58.11 is considered a secondary code, they do NOT want it listed as primary. Also if you read the LCD's there are very few chemo drugs that will pay if the secondary site is noted as primary. They still want the primary cancer dx listed as primary.
 
r&rmorales said:
Per Texas Medicare Guidelines. V58.11 is considered a secondary code, they do NOT want it listed as primary. Also if you read the LCD's there are very few chemo drugs that will pay if the secondary site is noted as primary. They still want the primary cancer dx listed as primary.
Click to expand...

Medicare guidelines cannot supersede the coding guidelines from the CDC, the are a set of coding rules required to be adhered to under HIPAA. V58.11 is first list only allowed.
 
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