V58.0 Encounter/Admission for radiation therapy

Janae

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ICD9 guidelines state this diagnosis code should always be primary. Should this code only be attached to the actual treatment codes (tech) or to all codes related to the patients care including pro charges?
 

kevbshields

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It is also acceptable as a Primary for professional fee services. The caveat here would be that as long as the services relate to radiation therapy of some sort, V58.0 is appropriate.

Good luck and hope this helps. You can see your ICD manual for further details.
 

AmandaW

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The ICD-9 guidelines does state to use primary, but there is an exception of when there are multiple encounters on the same day and the medical records for the encounters are combined or when there is more than one V code that meets the definition of principle dx.

SO...at my clinic we bill chemo drugs out with the cancer code, then put the ca code and
V58.11 or V58.12 secondary when doing the administration codes for the chemo. They usually have an office visit on the same day too which we would put a modifier 25 on. But even if they don't have an office visit or anything, the payors have told us they absolutely do not want to see the V58.xx codes first. Payor vs. ICD-9 guidelines. Payor trumps, right?
 

mitchellde

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No the coding guidelines trump.
These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-9-CM itself.
Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings.

V58.11, and V58.12 are first listed only and it is non compliant to list these codes secondary. If the office visit vist is for a planned chemo encounter then you cannot charge the ov code with the 25 modifier.
 

mitchellde

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No the coding guidelines trump.
These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-9-CM itself.
Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings.

V58.11, and V58.12 are first listed only and it is non compliant to list these codes secondary. If the office visit vist is for a planned chemo encounter then you cannot charge the ov code with the 25 modifier.
 

mitchellde

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Your post is not really clear. If the patient presents for radiation therapy the the V 58.0 code for encounter for radiation therapy is first listed followed by the neoplasm code. If the encounter is for other reasons then you code whatever the reason for the encounter is, the fact that the patient is currently undergoing radiation is not coded.
 
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