Oncology & Hematology Coding Alert
Here’s How You Should Use Z51.11
Question: I am having trouble finding a definitive answer as to whether Z51.11 should just be used on the chemo infusion itself or whether it is appropriate for the provider to use on the E/M visit prior to chemo administration. What should I do? Texas Subscriber Answer: Code Z51.11 (Encounter for antineoplastic chemotherapy) by definition is used for the encounter for chemotherapy. If there is an office visit the same day, you would use the diagnosis codes that apply to the chief complaint or reason why the patient is seeing the provider in the office visit that day. Also, if it is separate and identifiable, use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit (99211-99215, Office or other outpatient visit …). The documentation for the office visit should stand alone and be very clear as to what was being treated during office visit (separate from the chemo infusion).
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