Wiki Z51.11 Help!

[johnsda@gritman.org]

I'm trying to solve a disagreement between coding companies. Is Z51.11 an appropriate code for an encounter solely for growth factor administration when the growth factor is given as a supportive drug for an antineoplastic regimen given three days earlier? One place says it's not appropriate because the encounter itself isn't for an antineoplastic chemo drug. The other says it is because it is necessary part of the antineoplastic treatment as a whole, regardless of when the encounter occurred.

 

[tkermode]

The Z51.1* are only for the visit where a J9*** drug is administered.

According to the ICD guidelines, Section I.C.2.e.2, when other services integral to the antineoplastic treatment are performed (brachytherapy), you still don't assign Z51.0. The same logic applies to non-chemotherapy drugs integral to the chemotherapy regimen.

2) Patient admission/encounter solely for administration of antineoplastic chemotherapy, immunotherapy and radiation therapy

If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or external beam radiation therapy for the treatment of a neoplasm, assign code 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 the reason for the encounter is more than one type of antineoplastic therapy, code Z51.0 and codes from subcategory Z51.1 may be assigned together, in which case one of these codes would be reported as a secondary diagnosis.

The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis.

If a patient admission/encounter is for the insertion or implantation of radioactive elements (e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis. Code Z51.0 should not be assigned.

Per Noridian Medicare,

Administration of anti-anemia drugs and anti-emetic drugs by injection or infusion for cancer patients is not considered chemotherapy administration.

https://med.noridianmedicare.com/we...dling-and-unbundling-of-services-and-supplies
(check your CMS MAC if it's a different one)

I would ask the company that is telling you to use Z51.11 if they have a reference or resource they can provide that supports their view that a G-CSF injection is "administration of chemotherapy."