Wiki Infusion and Chemo Diagnosis Coding

[emmylouf]

Hello,

I am looking for a good resource that outlines appropriate diagnosis coding for chemotherapy and infusion billing. Is it appropriate to append all of the patients conditions that are being evaluated, managed or treated by the ordering physician for the infusion/chemotherapy or is it appropriate to only code those diagnosis the infusion/chemotherapy is being directed towards? Does anyone know if there is somewhere this can be found in writing. The guidelines simply state to either use the malignancy primary or the encounter for chemotherapy primary and the malignancy secondary, but do not answer the posed question on if the other treated conditions by the ordering physician are appropriate as well.

 

[rhondatalley]

Chemotherapy/infusion secondary dxs

Hello,

I am looking for a good resource that outlines appropriate diagnosis coding for chemotherapy and infusion billing. Is it appropriate to append all of the patients conditions that are being evaluated, managed or treated by the ordering physician for the infusion/chemotherapy or is it appropriate to only code those diagnosis the infusion/chemotherapy is being directed towards? Does anyone know if there is somewhere this can be found in writing. The guidelines simply state to either use the malignancy primary or the encounter for chemotherapy primary and the malignancy secondary, but do not answer the posed question on if the other treated conditions by the ordering physician are appropriate as well.

Section III of the Office ICD9 Guidelines for Coding and Reporting specifies which secondary diagnoses are to be included. If the diagnosis affects patient care in terms of requiring:
clinical evaluation
therapeutic procedures
diagnostic procedures
extended length of hospital stay: or
increased nursing care and/or monitoring

Generally, this means all conditions that the patient is on long term meds for or those that are chronic such as DM, HTN, CKD, etc. as well as any acute conditions that are being treated. Conditions that are resolved prior to the current encounter and no longer under treatment should not be coded, however, it may be reasonable to code the related history (V) code if it has a bearing on the current treatment. For example, if the patient is receiving chemotherapy for bladder cancer and has a history of multiple UTI's, but not a current UTI, then V13.02 should be coded as this information would be a consideration for the treating physician.

 

[DavaAdams]

Is it appropriate to refer to the "Treatment Plan" for the patient's chemotherapy to better specifiy the type of cancer that is being treated? Our coding policy states as follows, "Documentation for the date of service for therapeutic services must clearly indicate the diagnosis for which the service is being provided. Coders should review the evaluation/treatment plan for the date(s) of service being billed and all other documentation from the provider that supports the date of service being billed (i.e., order for the service, evaluation supporting the treatment plan for the service provided, treatment plan, progress notes)."

I have a new coder that this stating that other documents within the record cannot be referred to when assigning an ICD-9 code and that if the chemo "order" does not state the specific type of cancer that we are required to code an unspecified code.

Any reference documentation preferrably from CMS would be greatly appreciated.