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chemotherapy

  1. #1
    Default chemotherapy
    Medical Coding Books
    Patient has a hx of breast cancer, she is clear from cancer for 2 years, she comes in for a routine f/u and found that the cancer spread to the lymph node.
    How would you code for the chemo treatment do you code use V58.11, 174.9, 196.9 or v58.11, 196.9, V10.3?

    thank you.

  2. #2
    Location
    Columbia, MO
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    You would code the chemo admin first then the metastatic cancer code then the hx of breast cancer. The primary site is still free of disease, the cells moved to a new organ.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Thank you so much!

    Izabela

  4. #4
    Location
    Grand Rapids, MI
    Posts
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    Our claims are being paid for without the V58.11 code being used and our insurance carriers would not pay a claim using 196.9/V10.3. We bill using 174.9/196.9.

  5. #5
    Location
    Columbia, MO
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    Look at the coding guidelines if the reason for the encounter is chemo then V58.11 is required to be first listed. AHA coding clinics have stated on many occasions that you the cancer being treated next and if it is a metastatic cancer then you always list the primary also, and it can be active, hx of , or unknown. If there is no evidence of disease at the primary site and there is no residual tx being directed to the primary site then it is hx of and MUST be coded that way. We must remember that the dx is the patient's and not the carriers and we have a duty to code it as documented by the physician to acurately capture the patient's condition for data collection. The carrier cannot tell us what the patient's dx is.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    my claims are also being paid without the use of v58.11

  7. #7
    Location
    Columbia, MO
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    Is it possible that the drugs being given are not chemotherapy? If so that is fine for instance BRM drugs would not be coded as V58.11. But if the reason for the encouner is for the administration of chemo then you must use the V58.11 code.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    so if a patient is coming in specifically for the administration of chemotherapy, my first code must be v58.11?

  9. #9
    Location
    Columbia, MO
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    That is correct.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    [QUOTE=mitchellde;115392]Is it possible that the drugs being given are not chemotherapy? If so that is fine for instance BRM drugs would not be coded as V58.11. But if the reason for the encouner is for the administration of chemo then you must use the V58.11 code.[/QUOTE

    Hi Debra,

    I wanted to see if you know where I could get a quick reference to decipher if the drugs listed within the body of the progress notes are for chemo or not? I am having some difficulty deciphering the MDM on my encounters. I am very new to oncology coding and there is alot I need to learn.

    Thanks in advance,
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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