# After Care V Codes



## ARCPC9491 (Sep 19, 2008)

Question!
I have a patient who had a total mastectomy for breast ca. She's coming back for f/u because she is having a complication from her chemo.

Do you code V58.42 and 174.8 (in addition to her complication of course) or one or the other? 

Thank you!


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## lavanyamohan (Sep 20, 2008)

Hello,
V58.12 should be the primary Diagnosis code for the encounter for antineoplastic chemotherapy. This should not be followed by 174.8 as the cancer has already been plucked out by doing a mastectomy. Pain codes can continue as secondary diagnosis codes, etc.


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## ramcpc (Sep 20, 2008)

*Complication would be the primary!*

Hi...

If the patient came to hospital for her complication then the appropriate complication code and the f/up code(s) will be coded for this scenario. 

Since the patient already had mastectomy for her breast cancer, we could not code the 174.8. But in this case we can code history of breast cancer.

Thanks,
B.T.RamKumar, MBA,CPC.


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## Anna Weaver (Sep 22, 2008)

*v codes*

I was always under the impression that as long as they were being treated for the cancer (chemo or radiation), then you code the appropriate cancer code. The chemo code goes first and then the cancer. Otherwise, why would they be giving chemo if there is no cancer? Any other thoughts on this ?


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## dmaec (Sep 22, 2008)

I agree with Anna on this one - just because they did the mastectomy, does not mean the cancer is gone.  If that were the case, they wouldn't need the chemo treament.
And I agree with you ARCPC9491 - I would code the codes you stated along with the complication as you said.  I would not be coding the encounter for chemo V58.12 for this encounter as that is not why she's coming in.  She's coming in for complications of  her chemo encounter, not another chemo session (right?) not this time.
to my knowledge her cancer code can be coded until she is cancer free, no longer being treated in anyway for her cancer.
_{that's my opinion on the posted matter}_


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## janetmoh (Sep 23, 2008)

I agree - if they are being treated for cancer (chemo) than they still have it.  If they are receiving preventative (tamoxifen, femora etc) then they are s/p.


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## ARCPC9491 (Sep 23, 2008)

yeah ... I thought you would code for the cx too - 174.9 when you pull up the V code for after care, it says conditions classifiable to xxx.x -xxx.x but it doesn't say code in addition to the V code and when I pulled up the icd9 regs, it's not very clear ... but I'm going to go w/ what I originally thought -complication, cx code, V code.


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## junebug1969 (Oct 1, 2008)

I'm pretty sure that you don't code the V code for the chemo unless the complication occurred during the same admission (while she was having the chemo). However, you do code for the cancer. Until a physician determines that the cancer is no longer present, then it is considered present on admission. 

If dehydration is the complication then it must be coded if the treatment involved hydration (via IV, etc.). Primary diagnosis is the reason the patient sought care (i.e. Anemia caused by chemo, dehydration, etc.). Cancer is listed as a secondary diagnosis.


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