# Question regarding ICD-9 chemotherapy complications coding



## emashworth (Feb 17, 2014)

Hey Everyone 

I am preparing for my CPC exam, and I have a question about a Problem in the 2012 Step-By-Step Medical Coding Textbook:

A patient is admitted with uncontrolled nausea and vomiting after chemotherapy treatment for lung cancer.

A. How many codes would be needed to accurately report this case?__ ( plus an E code)
B. What is the first listed diagnosis?__
C. What is the secondary diagnosis?__
D. What is the code for the first listed diagnosis?__
E. What is the code for the secondary diagnosis and the E code?__, __

according to the answer key the correct answers are as follows:

A. Two
B. Uncontrolled nausea and vomiting
C. Lung cancer
D. 787.01 (nausea and vomiting)
E. 162.9 ( neoplasm, lung, primary) E933.1 ( Tables of Drugs and Chemicals, Antineoplastic Agents, Theraputic Use)

My question is if you should assign assign V58.11( Encounter for antineoplastic therapy) as the primary, followed by 787.01, 162.9, E933.1

That is the impression that I got when reviewing the chapter guidelines for neopolasms, section E-3. 

Any insight would be much appreciated!


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## Tonyj (Feb 18, 2014)

emashworth said:


> Hey Everyone
> 
> I am preparing for my CPC exam, and I have a question about a Problem in the 2012 Step-By-Step Medical Coding Textbook:
> 
> ...



Pt was admitted with nausea and vomiting AFTER having an adverse affect to the chemotherapy. V58.11 would imply you are administering the drugs at that particular encounter. Code assignment is correct as stated by the answer key.


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## tharal (Feb 18, 2014)

V58.11 is only a first listed diagnosis code, using when the encounter is for administration fo chemotherapy only. see the official icd guidelines
 "Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy :
If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy assign code V58.0, Encounter for radiation therapy, or V58.11, Encounter for antineoplastic chemotherapy, or V58.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence."

in the above mentioned scenario patient is coming with the after effect of chemo, so that should be the PDx followed by the malignancy and the E code to specify the adverse effect of chemo.

Hope it helps!

Thara L CPC H


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## emashworth (Feb 19, 2014)

Thank you for your help!


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