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Neulasta and V15.9

  1. Default Neulasta and V15.9
    Medical Coding Books
    We use V15.9 when a patient has received Neulasta after their chemo treatment and the chemo is not on the claim (e.g. chemo in June 30, Neulast in July and that's the only month's service - we bill monthly outpaitent hosp based clinic). However, we've experienced where a coder will not add the v15.9 without documentation on the order (order says ca dx only) to support it. My question is what type of verbiage needs to be in the notes in order to add Neulasta? This is a general coder and oncology is not their speciality. HELP

  2. #2
    Location
    Nashville, TN
    Posts
    39
    Default
    Why don't you use the cancer code, regardless of whether Neulasta is billed on the same claim as chemo?
    Len Hales, RN, BSN, CPC

  3. #3
    Location
    Grand Rapids, MI
    Posts
    57
    Default
    We also do not add V15.9 with Neulasta.
    Ann Campbell, CPC, CEMC
    Cancer & Hematology Centers of Western Michigan

  4. Default
    In order for Neulasta to get paid and chemo administration is not on the claim, we would add the V15.9 along with the cancer code (per the LCD). We've experienced denials if just the cancer code is used by itself.

    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.

  5. #5
    Default
    You might want to review your LCDs. According to ours, the indications for Neulasta (given for CIN) require the use of V58.11/V58.12 as a primary and 288.03 as a secondary dx. It appears that some of our carriers would not pay without seeing a ca dx (in the third place) on the claims. Best regards!
    Lioubov Petrova, CPC, CHONC, CEMC, CPMA

  6. Default Neulasta
    We've received denials if the V15.9 is not on the claim and chemo was not given in the same claim. We only ue V58.11 if they are getting chemo.

  7. #7
    Default
    I code for oncology and we always bill V66.2 (convalescence care following chemo) and then the cancer diagnosis. We always get paid.

  8. Question
    Quote Originally Posted by erin30 View Post
    I code for oncology and we always bill V66.2 (convalescence care following chemo) and then the cancer diagnosis. We always get paid.
    So if a patient has chemo on Monday then 24 hours late has a Neulast injection on Tuesday, you code V66.2? We bill on a monthly basis so if the patient has chemo on June 30 then Neulasta on July 1 and that's the only service for that month, we bill the cancer code and V15.9 and it is covered but if we don't include V15.9, it's a denial provided it's the only service on the claim. I didn't think V66.2 was appropriate if they were continuing to get chemo.

  9. #9
    Default
    Its pallative care following chemo, not necessarily meaning they are no longer receiving chemo at all, but meaning they need additional care because they are on chemo. Seeing how Nuelasta is not given on the same day as chemo, it falls into that category of convalescence/pallative care. Hope that makes sense.

  10. #10
    Default
    we always use the v66.2 and the cance dx and we always get paid


    tdplair

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