Alicia: Oh, chemotherapy coding. How exciting. They actually had a question, I think, if you click on that first, I think there was… I’m having trouble with the sample test question. Okay, it says, “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 the testing will continue during treatment. Today, Sarah started chemotherapy. Treatments with what diagnosis code would Dr. Aaron report for today’s treatment?”
Chemotherapy Coding – VIDEO
Okay, scroll down. The answer key is stating the correct answer is D. My questioner… “Confusing is when I see the coding guideline note under V58.11 where it states ‘patient’s admission is solely for the administration of chemotherapy, assign V58.00’ which, by the way, that’s not correct. ‘Encounter for radiation therapy or V58.11, etc.’ Therefore, I would not have chosen D because Sarah is starting chemotherapy treatments on this visit. There was no mention of radiation. I chose A because the coding guideline note. How do I see this clear.
Okay so what I did was I broke it down. There’s… when you go to that section with the V codes for chemotherapy, there’s 3 main types of treatment that you’re getting for your cancer when they come in. The V codes is… if they’re getting radiation which is V58.0, that’s where the person who asked the question made the error. V58.0 is actually for radiation therapy, not chemotherapy. And then V58.11 is the encounter for antineoplastic chemotherapy and then V58.12 is the encounter for antineoplastic immunotherapy. So this code will be used first for every encounter, followed by the cancer code.
I’ll have to scroll down. Even if the patient has a complication from the chemo in the guidelines state that the V codes go first. So when you read the guidelines that are around these codes, it tells you that the V code goes first followed by cancer diagnosis then what the patient is suffering from. It’s common for when the person has chemotherapy for them to get nausea and vomiting and dehydrated after their chemotherapy. So when a patient is admitted for chemotherapy and then develops one of these complications, you still code the therapy first. So keep that in mind. Your V codes are always going to go first.
So we have an example where a patient who’s admitted for chemotherapy, for plasma cell leukemia. It’s going to be V58.11 because they’re getting chemotherapy, not radiation or that immunotherapy and their cancer’s coded 203.10.
Now our next person, Betty, was admitted for chemotherapy for giant cell leukemia and after her treatment was finished, she developed nausea and vomiting that was not relieved. So she was treated for the nausea and vomiting. So for that encounter, you’re going to still do the V58.11. Even though she had the nausea and vomiting, it’s still V58.11. The cancer’s 207.20 and then the nausea and vomiting is 787.01. So there’s no reason ever not to put that V code first.
Now some people don’t know what these terms were so I pulled these off from Find the Code that has the definitions of them. Antineoplastic… what that just means is that they’re giving you… that’s a medication that’s used to take care of the malignant cells. And then the chemotherapy, the definition for that is… oh, it’s on the next page of it because it was so big. The treatment of disease by chemical agents originally applied to use of chemicals that affected the caustic organism unfavorably but do not harm the patient. And of course, they usually just say chemo. You won’t see chemotherapy but it is a therapy that they’re doing.
So if you go back to his question… oh no, are we able to go back? He’s… if you just eyeball that real quick, she got chemotherapy. So it would be V58.11 because we know that chemotherapy is what they got and that’s the code, V58.11 and it goes first.
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Patient presents to office for continued management of cancer, exam, lab and chemo. There is an E/M level, labs and chemo billed. Should the V58.11 be listed primary on E/M level as well as on premeds, drugs and administrations?