V66.2 -- Primary or Secondary DX code?

[kellit21]

Hi, Can anyone tell me when Diagnosing an account with v66.2 would you code it first, or after the cancer dx?
Example... A patient is given a Neulasta injection and the patient has 174.2 (upper-inner quadrant of breast) How would you code this?

 

[davidsnk]

V66.2 is not the correct code to use with a Neulasta injection.

V66.2-Convalescence and palliative care follwing chemotherapy.


It depends on your insurance carrier/Medicare carrier as ours (NGS) wants the chemo code V58.11 primary and the malignant code second.

On all others we use 288.3 and the malignant code second. We have never had a problem with reimbursement. I hope this helps.

 

[mitchellde]

You cannot use the V58.11 for neulasta as it is not chemo, you do not use V66.2 as it is not palliative care, it is given primarily to reduce the risk of infection due to chemotherapy induced neutropenia, you also would not auto assign 288.3 unless that is specifically indicated by the provider in the note. We code only the diagnosis documented by the provider for that encounter, do not assume you know the reason for any particular drug or therapy.

 

[hmassimino]

We always bill V66.2 as the primary Dx for Neulasta, 288.03/288.09 as secondary and the cancer dx as 3rd Dx. We've never had rejections.

 

[mitchellde]

No you would not have a rejection but the V66.2 is incorrect coding and without the documentation I do not know of the other codes are correct, but you cannot assign 288.03 / .09 unless specifically documented. If it is documented as drug induced neutropenia the you must also assign the E code for adverse reaction to the medication . Guys just because you are getting paid does not mean you coded it correctly for the documentation. We must always be correct in assignment of the patient's condition because it is their diagnosis not yours!