Oncology & Hematology Coding Alert

Question: How do I choose between V58.11 and V58.12?

Illinois Subscriber

Answer: Distinguishing chemotherapy from immunotherapy will help you decide whether V58.11 (Encounter for antineoplastic chemotherapy) or V58.12 (Encounter for antineoplastic immunotherapy) belongs on your claim.

Immunotherapy stimulates the body's ability to fight disease. Chemotherapy, on the other hand, attacks cancer cells. You should refer to individual payer guidelines for a complete list of drugs that qualify as immunotherapy. The American Cancer Society lists the cytokine IFN-alfa (J9214, Injection, interferon, alfa-2b, recombinant, 1 million units) and the monoclonal antibody rituximab (J9310, Injection, rituximab, 100 mg), among many others (www.cancer.org/docroot/ETO/eto_1_3_Immunotherapy.asp).

Remember: ICD-9 guidelines instruct you to report V58.1x codes as the primary code if the encounter is solely for chemotherapy or immunotherapy. If the patient receives both antineoplastic chemotherapy and antineoplastic immunotherapy at the same encounter, ICD-9 guidelines indicate that you may report both codes in any order.

Also, V58.11 and V58.12 are specific to antineoplastic encounters. That means that if your practice administers chemotherapy or immunotherapy for a nonneoplastic condition, these codes are not appropriate. Instead, ICD-9 guidelines instruct you to code the condition.

On the horizon: When you swap ICD-9 for ICD-10 (currently planned for 2013), these encounter V codes may change to Z codes. ICD-10 2010 (www.cdc.gov/nchs/icd/icd10cm.htm#10update) includes the following codes:

• Z51.11 -- Encounter for antineoplastic chemotherapy

• Z51.12 -- Encounter for antineoplastic immunotherapy.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Los Angeles-based Sinaiko Healthcare Consulting Inc.