Wendy CPC
Contributor
We are having a patient start Alimta (Pemetrexed) next week and will be giving a B-12 shot in the day(s) prior as a preventative measure from the complications of Alimta. What ICD-9 is appropriate to use for this?
Since B12 is a part of Alimta protocol, we have been reporting it with one of 162.x series codes and "per Alimta protocol" under Additional info on CMS-1500.
From reading the original question I presumed that the patient had already been diagnosed with a lung ca (otherwise, I don’t see how Alimta regimen can be justified – one doesn’t precert a chemo regimen without dx, documentation, MD’s orders in place or at least, one shouldn’t).
Patients undergoing treatment with Alimta are advised to take folic acid daily and B12 supplements for the duration of treatment. IV injection of B12 is recommended preceding the first dose and every three cycles after that. Payers do consider (at least those I’ve worked with so far) IV B12 injection a “part of Alimta protocol”.
With the diagnosis documented, and chemo tx plan targeting the dx in place, fraud is non-issue.
That is not to say, that V70.8 cannot be reported or that reporting 162.9 with “per Alimta protocol” is more correct.
Best regards!