Chemotherapy Treatment

[Suzanne]

I am having trouble with a sample test question...
Dr. Aaron, an oncologist, completed a consult for Sarah, who has metastatic malignant melanoma in the anterior stomach wall. At this time, the primary site is unknown and testing will continue during treatment. Today, Sarah started chemotherapy treatments. What diagnosis codes would Dr. Aaron report for today’s treatment?
a. V58.0, 151.8, 197.8
b. 151.8, 197.8, V58.0
c. 199.1, 197.8, V58.11
d. V58.11, 197.8, 199.1

The answer key is stating that the correct answer is d. My question/confusion is when I see the Coding Guideline Note under V58.11 where it states that if the patient admission is solely for the administration of chemotherapy assign V58.00. Encounter for radiation therapy or V58.11, etc. Therefore, I would not have chosen d because Sara is starting chemotherapy treatments on this visit. There is no mention of radiation. I chose "a" because of the "Coding Guideline Note"...How do I see this clearer?

 

[Carolyn Heath]

The first thing that pops in my mind is two questions: What did the person came in for? Why is the patient there? The patient came in for a chemotherapy treatment. That eliminates b & c because you would list the V code as first diagnosis. Now you are going to look at the two V codes. V58.0 is for radiotherapy and V58.11 is for an encounter for atineoplastic chemotherapy. Also, the patient has metastatic malignant melonoma in the anterior stomach wall, but that is not the primary site. The primary site is where the cancer started. In this case, the primary site is unknown with the cancer in the stomach is secondary. I agree with the answer key that the correct answer is D. You have to look up the codes and read the description after you eliminated b & c.

 

[Ruth Sheets]

This was answered in the December 2012 Q &A Webinar. Below are some key points discussed. You can view the replay at www.cco.us and click on Q and A Webinar Replay link. This is a replay club so you get access to all the past replays as well as future ones.


When a patient is admitted for ongoing treatment of cancer there are three basic V Codes to know:

1. V58.0 Encounter for radiation therapy
2. V58.11 Encounter for antineoplastic chemotherapy
3. V58.12 Encounter for antineoplastic immunotherapy.

This code will be used first for every encounter followed by the Ca code. Even if the patient has complication from the chemo the guidelines state that the V Code goes first followed by the Ca dx then what the patient is suffering from. It is common to experience nausea, vomiting and dehydration after chemotherapy. When a patient is admitted for chemotherapy and then develops one of these complications you still code the therapy first.






Example: Ben was admitted for chemotherapy for plasma cell leukemia. V58.11, 203.10 Betty was admitted for chemotherapy for giant-cell leukemia and after her treatment was finished she developed nausea and vomiting that was not relieved. She was treated for the N/V. V58.11, 207.20, 787.01

 

[Kristen Savage]

Why dont you try surfing the net, I have found a lot on the web when i was in your position

 

[Carolyn Heath]

Kristen, that was discussed in the last (January 2013) webinar!