PDX for Neulasta

NJcoder

Expert
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Pt. visit for Neulasta injection only and has breast cancer. Would 174.8 be pdx or V66.2?
Thanks.
 

NJcoder

Expert
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only breast cancer.
i thought Neutropenia or some kind of anemia is the reason for Neulasta?
 

mitchellde

True Blue
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Columbia, MO
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Are you looking at the encounter note? If there is no indication for the treatment given within the encounter note then I would send the note back to the provider with a query indicating you need documentation for the medical necessity for the treatment.
 

crhunt78

Guru
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Sometimes Neulasta is used as part of certain treatment regimens and you can use the prophylactic use code V07.8 (per the Medicare LCD) but you definitely need to find out if the patient is receiving the drug because of neutropenia or prophylactically.
 

nlaaron

Networker
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SUMTER
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You would use the V66.2 as pxd and then the cancer dx as long as she really did have chemo sometime prior. We always bill this way and have no trouble getting paid.
 
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