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 [...]