# Neulasta and V15.9



## traci.susong@gmail.com (Aug 25, 2011)

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


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## lch (Aug 25, 2011)

Why don't you use the cancer code, regardless of whether Neulasta is billed on the same claim as chemo?


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## abc1099 (Aug 26, 2011)

We also do not add V15.9 with Neulasta.


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## traci.susong@gmail.com (Aug 26, 2011)

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.


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## lpetrova (Aug 27, 2011)

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!


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## traci.susong@gmail.com (Nov 16, 2011)

*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.


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## nlaaron (Nov 17, 2011)

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


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## traci.susong@gmail.com (Nov 18, 2011)

erin30 said:


> 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.


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## nlaaron (Nov 22, 2011)

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.


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## tonplair@gmail.com (Nov 26, 2011)

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


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## LoveCoding (Nov 27, 2012)

*Neulasta*

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.


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## Rachel.Kinsey@mercy.net (Sep 29, 2013)

*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-coverag...SearchType=Exact&kq=true&bc=IAAAABAAAAAAAA==& 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.


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## OCD_coder (Sep 29, 2013)

_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.

288.03 DRUG INDUCED NEUTROPENIA 
284.11 ANTINEOPLASTIC CHEMOTHERAPY INDUCED PANCYTOPENIA 
V07.8 OTHER SPECIFIED PROPHYLACTIC OR TREATMENT MEASURE 
V15.9 UNSPECIFIED PERSONAL HISTORY PRESENTING HAZARDS TO HEALTH 
V42.82 PERIPHERAL STEM CELLS REPLACED BY TRANSPLANT 
V58.11 ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY 
V58.12 ENCOUNTER FOR IMMUNOTHERAPY FOR NEOPLASTIC CONDITION 
V66.2 CONVALESCENCE FOLLOWING CHEMOTHERAPY


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## Spursfan26 (Jan 6, 2014)

*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.


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## Laura Pillsbury (Jun 4, 2014)

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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