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Oncology & Hematology Coding Alert

Reader Question:

Chemo Patients Get 1 V Code, 1 Dx Code on Claim

Published on Mon Nov 15, 2004

Question: One of our physicians recently treated a trachea cancer patient with chemotherapy infusion for 1 hour and 55 minutes. Is the V58.1 (Chemotherapy) code enough to prove medical necessity for the chemo session?

Arkansas Subscriber
 
Answer: The V58.1 code should prove medical necessity on the claim, but the V code should be accompanied by another diagnosis code that describes the cancer the oncologist is treating. Otherwise, your claim may not be acceptable to the payer.

Don't rely on a V code alone; on your claim, you should:

  • report 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) for the first hour of the chemo infusion

  • report +96412 (... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure]) for the remaining infusion time

  • report ICD-9 code 162.0 (Malignant neoplasm of trachea, bronchus, and lung; trachea) with 96410 and 96412 as the secondary diagnosis code, unless payer
    guidelines instruct otherwise

  • report V58.1 with 96410 and 96412 as the primary diagnosis code, based on the official AHA guidelines.

    General Guidelines: According to the ICD-9 manual, oncology practices should employ V codes when:

  • a person not currently sick avails himself of your office's services (for prophylactic vaccinations, as organ/tissue donors, etc.)

  • a person who already has a known disease or injury avails herself of your office's services for treatment of that specific disease.

  • a person avails himself of your office's services for a problem that affects his health but is not necessarily an illness or injury.

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