dbrewbaker
New
The guideline for Z51.11- Encounter for antineoplastic chemotherapy and Z51.12- Encounter for antineoplastic immunotherapy is being argued as to what way it should be applied.
One side is saying that these codes should be applied to claims for patients who are being treated for a cancer with a chemo-drug. (Applied based on patient's condition.)
The other side is saying that these codes should be applied to claims for any patients who are receiving a chemo-therapy drug, regardless of whether the patient has cancer. (Based on type of drug being used.)
For example, if the patient is receiving Rituximab for Krohn's Disease
Side 1 is saying not to use Z51.11 or Z51.12 because the patient does not have cancer.
Side 2 is saying Z51.11 or Z51.12 is required because the patient is receiving a chemo-type drug that requires a CPT code for Chemotherapy administration (96401-96417).
So... Which side is correct?
The ICD 10 CM Official Guidelines on these codes is found in:
C. Chapter-Specific Coding Guidelines, Section 2. Chapter 2: Neoplasms (C00-D49) General guidelines (Which gives the impression it is effective to only these C&D codes. But the ambiguity is found in the wording of the actual explanation for use of the code, found in subsection 2.)
e. Admissions/Encounter involving chemotherapy, immunotherapy and radiation therapy
2) Patient admission/encounter chiefly for administration of chemotherapy, immunotherapy and radiation therapy. If a patient admission/encounter is chiefly for the administration of chemotherapy, immunotherapy of external beam radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission, more than one of these codes may be assigned, in any sequence.
The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis.
For side 1 the argument can be clearly made that it's use is described in the section governing C&D code Neoplasms and that these codes require the secondary diagnosis of a malignancy.
For side 2 the argument can be made that the guideline is stating the use of this codes is "chiefly for the administration of" the type of therapeutic drug being used, therefore if CPT codes 96401-96417 are being used, Z51.11 and/or Z51.12 should also be used regardless of whether the patient has a neoplasm to treat.
Which is the correct answer?
One side is saying that these codes should be applied to claims for patients who are being treated for a cancer with a chemo-drug. (Applied based on patient's condition.)
The other side is saying that these codes should be applied to claims for any patients who are receiving a chemo-therapy drug, regardless of whether the patient has cancer. (Based on type of drug being used.)
For example, if the patient is receiving Rituximab for Krohn's Disease
Side 1 is saying not to use Z51.11 or Z51.12 because the patient does not have cancer.
Side 2 is saying Z51.11 or Z51.12 is required because the patient is receiving a chemo-type drug that requires a CPT code for Chemotherapy administration (96401-96417).
So... Which side is correct?
The ICD 10 CM Official Guidelines on these codes is found in:
C. Chapter-Specific Coding Guidelines, Section 2. Chapter 2: Neoplasms (C00-D49) General guidelines (Which gives the impression it is effective to only these C&D codes. But the ambiguity is found in the wording of the actual explanation for use of the code, found in subsection 2.)
e. Admissions/Encounter involving chemotherapy, immunotherapy and radiation therapy
2) Patient admission/encounter chiefly for administration of chemotherapy, immunotherapy and radiation therapy. If a patient admission/encounter is chiefly for the administration of chemotherapy, immunotherapy of external beam radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission, more than one of these codes may be assigned, in any sequence.
The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis.
For side 1 the argument can be clearly made that it's use is described in the section governing C&D code Neoplasms and that these codes require the secondary diagnosis of a malignancy.
For side 2 the argument can be made that the guideline is stating the use of this codes is "chiefly for the administration of" the type of therapeutic drug being used, therefore if CPT codes 96401-96417 are being used, Z51.11 and/or Z51.12 should also be used regardless of whether the patient has a neoplasm to treat.
Which is the correct answer?
