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Thread: Neulasta and V15.9

  1. #11

    Default Neulasta

    AAPC: Back to School
    When I use the CA code and V07.8 (need for prophylactic or treatment measures), I don't get an edit. When I put prophylactic,administration of, neulasta into the encoder, it gives me V07.8.

  2. #12
    Join Date
    Apr 2007
    Springfield Missouri

    Default Neulasta and V159 the long answer

    According to LCD L25820 only V15.9, V58.11, V58.12 and V66.2 support medical necessity for pegfilgrastim. Notice how it does not list V078!! The language there is super confusing but after stating that it will cover in prophylactic instances, it states further down that “V159 should be reported when pegfilgrastim is used to decrease the incidence of infection, as manifested by febrile neutropenia in patience with non-myeloid malignancies receiving myelosuppressive cancer drugs.” So if you’re getting denied when using V078, THAT’S why! Even though it SAYS prophylactic, it is very specific as to what to use. (here’s the link to that http://apps.ngsmedicare.com/SIA/ARTICLE_A48208.htm though you may have to copy/paste) That also means that when the doctor says preventative, prophylactic, etc., you can safely use V159. So, the verbiage we mainly look for in the chart is any language that will support those codes, specifically high risk as in "high risk of toxicity and myelosuppression".

    According to the LCD L30306 (found on CMS.gov here’s the link: http://www.cms.gov/medicare-coverage...AAAAAAA%3d%3d& sorry so long ) coverage guidance gives indications for Neulasta as:
    E. Indications for Pegfilgrastim (Neulasta™): (J2505)
    1. To decrease the incidence of infection, as manifested by febrile neutropenia, for patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of febrile neutropenia
    2. Prophylactically used to decrease the incidence of infection, for patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of febrile neutropenia
    3. Administration may be indicated for patients at high risk for chemotherapy-induced infectious complications. Such risk factors may include the following (V15.9) and should be documented in the patient record:
    a. Pre-existing neutropenia due to disease,
    b. Extensive prior chemotherapy
    c. Previous irradiation to the pelvis or other areas containing large amounts of bone marrow.
    d. A history of recurrent febrile neutropenia while receiving earlier chemotherapy of similar or lesser dose-intensity
    e. Conditions potentially enhancing the risk of serious infection.

    When hx of radiation is documented, I use the V153 code in addition to the V159 to further identify the risk, same with hx of chemo (v8741). And of course when we can’t find the language above in the chart (or to identify the “E” up there since that is left open) we sigh the big sigh and query the doc to get as close to as possible because Neulasta is so tricky. Sorry such a long answer.

  3. #13
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    My question is what verbiage should be in the medical record to alert the coder to add
    V15.9 when Neulasta is the only drug on the claim.

    As far as what is needed for documenting for use of the V15.9 to be used by a non-oncology coder, this is kind of a vague Dx code and I would think there are other options not to use. But, the coder will need to understand the "stage" the patient is in, that would should be described by the provider; but also they need to just simply understand when it's the only thing performed that day the Ca cannot be listed 1st. So additional "documentation" really shouldn't be required, education of the coder would be the best option.

    Just a reminder for the general coding population, local LCD's trump CMS NCD's as the local LCD's can be more restrictive than the national rules. Not knowing what your MAC carrier is, I have included the NGS LCD diagnosis that meet medical necessity as of today's date. Not sure where the NGS article listed above came from but it is dated with a last revision of 2009. V07.8 is accepted by NGS and pays without difficulty for my clinic. A representative of NGS explained how to select the diagnosis code correctly to us thusly:

    Use v07.8 for a patient not receiving chemo on the same day, who is in a current chemotherapy treatment cycle and has not been diagnosed with drug induced neutropenia or pancytopenia yet.

    Use V58.11, or V58.12 when given on the same day as a chemo drug and no presence of neutropenia or pancytopenia.

    Use V66.2 when the patient is between chemotherapy treatment cycles and still requiring medication management to prevent neutropenia or pancytopenia type infections. This applies within the immediate 3 months following a chemo cycle.

    Last edited by OCD_coder; 09-29-2013 at 03:41 PM.

  4. #14

    Default Brigette, CPC

    I went to an Oncology coding seminar and was told to bill Neulasta you need 1) 288.03 2)cancer 3) E933.1. in that order for dx codes. Ever since I learned this all claims have been paid with no problems.

  5. #15


    There is a Coding Clinic on Neulasta injections 2010 second quarter that states V07.8 should be the primary code followed by the cancer

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