Wiki Inpatient Chemo Encounter

[Lanserr]

When the physician is documenting for a Chemo Encounter, should or should they not being documenting the specific cancer, within thier progress note for that day? I understand that the visit is for Chemo, and that I need to use the V code first, but shouldn't I also have the cancer/neoplasm documented?

 

[mitchellde]

yes the cancer must be documented in the progress note in order to code for the chemo administration.

 

[Lanserr]

Thank you Debra!! I was sure it was supposed to be... Was trying to be convienced otherwise. Your response is greatly approeciated!