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Need Diag for prophylatic treatment

  1. #1
    Default Need Diag for prophylatic treatment
    Medical Coding Books
    Hello,

    Is there a code for this? My patient is admitted for a round of Chemo for an established cancer. The #of diag is one (estab cancer) and the risk is high for the chemo. The patient does not have nausea, so I have not been coding this as a new or estab problem, however; I'm being told there should be a code for this. I've been using V58.69 on the bill, but not counting it
    as it's not a new,estab self limited problem. I am billing 99221 and told wrong.
    Can anyone help me out please?

    Thanks,
    Cathy

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    For the admission for chemotherapy, there is a diagnosis code of V58.11 to be used - perhaps that is what whoever is telling you means? However, for the admission code of 99221, we wouldn't be able to tell without knowing the level of history, exam, and MDM.

    Thanks,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Default
    Yes, we would use the V58.11 and then for example 162.9 for the diag for CA.
    The exam and MDM would be comprehensive/high. I still have 1 established diag. I am being told I should code the nausea even though the patient does not have it b/c they are being treated. Then I would have an additional diagnosis and could get a higher level. I run into the same issue for DVT prophylaxis as well.

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    OK - so the exam is comprehensive; what is the history? Also, you state that the MDM is high - do you mean that the risk is high (based on the drug therapy requiring intensive monitoring for toxicity), but the amount of data is not high, and others want you to increase the number of diagnoses you are coding in order to meet extensive on that, to make the MDM high? In the provider's H & P, does he/she list nauseau under assessment or diagnoses? Sorry that I have more questions than answers.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Default
    The patient's hx is comp, and the exam and yes the risk is high because of the drug-chemo, you are correct. The amount of data may not be high, and with the established cancer giving me 2 points, I am being told to give 1 point for the prophylatic nausea that way I can bill a 99222, rather than a 99221. I have never heard of this before.

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