Oncology & Hematology Coding Alert

When coding for chemotherapy-related treatment, oncology practices should use either the cancer diagnosis code or other code listed in the main section of the ICD-9-CM as the primary one to ensure payment. Using V codes, such as V58.1 (encounter for other unspecified procedures and aftercare chemotherapy) as a primary diagnosis should be avoided in favor of those that provide a more accurate description of the patients condition.

Many oncology practices use V codes as the primary diagnosis code, when they should only be used as secondary diagnosis codes, says Nancy Giacomozzi, office manager for P.K. Administrative Services, a Lakewood, Colo.-based medical billing firm. The ICD-9-CM manual is very clear in its definition of how V codes should be utilized.

There are a number of other oncology-related V codes. They include:

V07.3 (other prophylactic chemotherapy);
V10.0-V10.9 (personal history of malignant neoplasm);
V16.0-V16.9 (family history of malignant neoplasm);
V66.2 (convalescence and palliative care following chemotherapy);
V67.2 (followup examination following chemotherapy); and
V76.0-V76.9 (special screening for malignant neoplasms).

However, Giacomozzi and Nancy Cothern, practice administrator at the Baptist Cancer Institute, an oncology practice in Jacksonville, Fla., believe practices should avoid using them. For instance, 174.0 (malignant neoplasm of female breast) is still the proper diagnosis code for a patient who returns for followup after successful treatment of breast cancer.

Supplemental Use of V Codes

Despite the number of V codes available, Cothern uses only V58.1 and avoids listing others on claims. She does not use it as a primary diagnosis code, but as a secondary diagnosis for procedures related to chemo-therapy treatment.

V codes are supplementary codes and add more detail to the general diagnosis. They are listed in the ICD-9-CM to deal with cases in which circumstances other than a disease or injury classifiable to the general section of the ICD-9 are the reason the patient is being treated.

For example, a patient who is undergoing anti-emetic therapy for chemotherapy-induced nausea may require V58.1 to be listed as the secondary diagnosis. Code 787.0 (nausea and vomiting) or 787.01 (nausea with vomiting) can be used as the primary diagnosis. Some payers may require a primary diagnosis of cancer (140-208.9 malignant neoplasms) when billing for anti-emetic drug administration. For others, 787.0-787.1 is required as a secondary diagnosis, eliminating the need for the V58.1, Giacomozzi says.

In addition to the above codes that establish medical necessity, oncology practices should also include the drug (J code) and procedure code. For example, Granisetron (J1626) is a common anti-emetic used as an adjunct to chemotherapy. Oncology practices should include the J code if the anti-emetic therapy is provided to the patient receiving chemotherapy (96410 infusion technique, up to one hour).

Another common procedure associated with V codes is the administration of epoetin alfa, (Q0136) which is used to combat chemotherapy-induced anemia. Coding for this drug varies from payer to payer. Proper reimburse-ment requires providers to check with their individual carriers. Depending on the carrier, the procedure can include either V58.1 or 140.0-204.91 as the secondary diagnosis. Code 285.8 (other specified anemias) or 285.9 (anemia, unspecified) is often used as the primary diagnosis for epoetin alfa administration.

Anti-emetics and epoetin alfa are two examples of where V codes can be used, but oncology practices may come upon less common cases where they seemed appropriate. Oncology practices should understand that supplementary use of V codes occurs mainly in these three circumstances:

1. When a person who is not now sick encounters the health services for some specific purpose, such as to act as an organ or tissue donor, to receive prophylactic vaccination, or to discuss a problem which is not a disease or injury;

2. When a person with a disease or injury, whether it is current or resolving, encounters the healthcare system for a specific treatment of that disease; and

3. When some circumstance or problem influences the persons health status but is not a current illness or injury. Such factors may be elicited during population surveys, when a person may or may not be currently sick, or may be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to HCPCS categories 001-999.

Exception to the Rule

Giacomozzi says, The family history codes are the only exception to not using V codes as a primary diagnosis. These describe specific malignancies within a patients family.

A common example is when a patient comes in for a visit with a suspicion of cancer, perhaps prompted by a family history of breast cancer. Listing V16.3 can prove medical necessity for the visit. These V codes are appropriate as a primary diagnosis because no other illness is present.

V codes, Cothern says, should be avoided as much as possible. Instead, medical oncology practices should find a more specific description of medical necessity through codes contained in the main section of the ICD-9-CM.