Prophylactic Neumega/Filgrastin Injections

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Ksheon

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I'm running into a problem with these accounts. Coding clinic states to use Z76.89 but billing wants Z41.8 so that these accounts will actually get paid as no one is accepting the Z76.89. Any suggestions on other codes to use that both accurately portray the prophylactic injection that are being accepted?
 
The codes that we used in ICD 9 for those accounts was v078 (Other specified prophylactic or treatment measure) and/or V159 (Unspecified personal history presenting hazards to health). In ICD 10, those codes become z418 and z91.89, respectively.
 
Z41.8 codes out to Encounter for other procedures for purposes other than remedying health state.

It is in the same code block as Encounter for cosmetic surgery and Encounter for Ear piercing. The purpose of a Neumega injection is to remedy a health state which seems to be the exact opposite of what this code is intended for. In the ICD-9 to ICD 10 comparison report Z41.8 translates to V50.8.

What I'm asking is; other than Z76.89 and Z41.8, is anyone using any other codes on these accounts?


Prophylactic Neulasta injection for infection prevention
Coding Clinic, Second Quarter ICD-10 2014 Page: 10 Effective with discharges: May 26, 2014

Question:

A patient who is receiving ongoing chemotherapy for lung cancer presents for Neulasta injection to prevent infection. The patient receives the Neulasta via a subcutaneous injection. The advice provided in the Second Quarter 2010 issue of Coding Clinic for ICD-9-CM advised coders to report code V07.8, Other specified prophylactic or treatment measure, for an encounter for Neulasta administration to prevent an infection. However, there does not seem to be an equivalent code in ICD-10-CM. What are the appropriate diagnosis and procedures codes for an encounter for Neulasta to prevent infection?

Answer:
Assign code Z76.89, Persons encountering health services in other specified circumstances, as the reason for the encounter. Assign also the appropriate code assignment to describe the patient's cancer. In this case, assign code C34.90, Malignant neoplasm of unspecified part of unspecified bronchus or lung.
 
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Isnt it strange how using the AAPC crosswalk from Icd9 to ICD 10 for V078 walks to Z418 but walking it from ICD 10 to ICD 9 gives V508. That startled me, actually, so I walked it out using 3M Encoder, which is the coding program we use and it gave me the same code your billing dept asks for. As to your question of other codes being used, we are using z91.89 also. Thus far we have only been using the codes I've cited, though because of your question and Coding Clinic question, have brought this to my manager for clarification in our own practice. I know I haven't helped you, but you really have helped us.
 
Want to give you a quick update: the reason the coding clinic recommended code is not paying, is because the LCD for this changed. While the definitions stayed the same, the list of codes that cover for medical necessity changed, and no longer include prophylactic or high risk codes. Not the z418, not the z91.89 and not the z76.89. The LCD for this: Local Coverage Determination (LCD): Human Granulocyte/Macrophage Colony Stimulating Factors (L34699)

The website link is:
http://www.cms.gov/medicare-coverage-database/license/cpt-license.aspx?from=~/overview-and-quick-search.aspx&npage=/medicare-coverage-database/details/lcd-details.aspx&LCDId=34699&ContrId=143&ver=6&ContrVer=1&CntrctrSelected=143*1&Cntrctr=143&LCntrctr=143*1&DocType=Future&Accept=Y&bc=AgACAAIACAAAAA%3d%3d&

If that link isnt active, you can certainly copy&paste.
 
Rachel.Strzelecki@Mercy.net said:
Isnt it strange how using the AAPC crosswalk from Icd9 to ICD 10 for V078 walks to Z418 but walking it from ICD 10 to ICD 9 gives V508. That startled me, actually, so I walked it out using 3M Encoder, which is the coding program we use and it gave me the same code your billing dept asks for. As to your question of other codes being used, we are using z91.89 also. Thus far we have only been using the codes I've cited, though because of your question and Coding Clinic question, have brought this to my manager for clarification in our own practice. I know I haven't helped you, but you really have helped us.
Click to expand...

We use 3M as well and when I walk it through it gives me the z76.89

1.)Prophylactic>3.)Neulasta injection> Z76.89

After reviewing the link you provided (thank you :) ) Maybe Z92.21 Personal hx of Chemotherapy might work?
 
You would not use the history of chemo if the patient us still under going chemo or us between treatments. Do as the coding clinis instruct and use the code for the neoplasm secondary to the Z76 code.
 
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