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Dose of B-12 for preventative use

W

Wendy CPC

Contributor
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12
Location
Spokane, WA
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?
 
B-12 w/ Alimta

Th purpose of B-12 shot (w/ Alimta as a prophylaxis) is to prevent or reduced treatment-related hematologic and GI toxicities. My take on this is V07.2 Prophylactic Immunotheraphy. ICD-9 Index, main term: Prophylactic, under subterm: antitoxin.
 
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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.
 
lpetrova said:
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.
Click to expand...

?? If you assign a code from 162.x and the patient is not documented as having a malignant neoplasm of the lung, bronchus or trachea, then you are submitting a fraudulent claim. The coder may never determin the patient's dx. The drug is being given prophylactically so I agree with the V07.x.
 
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!
 
lpetrova said:
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!
Click to expand...

Alimta is also give for lung mets which is a different code. I am just cautioning the use of code per protocol and not per the patient's documented dx. I think use the V code for prophylactic admin with the appropriate cancer code secondary should work fine.
 
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