Oncology & Hematology Coding Alert

Question: If we provide amifostine for a lip cancer patient receiving radiation, which diagnosis codes should we report?

Florida Subscriber

Answer: For many payers, reporting the radiation encounter (V58.0, Encounter for other and unspecified procedures and aftercare; radiotherapy) and the appropriate neoplasm code (140.x, Malignant neoplasm of lip) will suffice to prove amifostine (J0207, Injection,amifostine, 500 mg) medically necessary.

Check your payer policies to get the final word on which codes -- supported by your documentation -- the payer requires on the claim for payment. For example, the First Coast Service Options local coverage  determination (LCD) for amifostine (L29059) states that Medicare will consider amifostine medically reasonable and necessary "to reduce the incidence of moderate to severe xerostomia in patients undergoing radiation treatment for head and neck cancers where the radiation port includes a substantial portion of the parotid gland."

In addition to the appropriate head and neck cancer codes, other codes payers may request for radiation patients include:

527.7 -- Disturbance of salivary secretion

909.2 -- Late effect of radiation.

Xerostomia: Radiation therapy can damage salivary glands, causing head and neck cancer patients to experience dry mouth (xerostomia). Amifostine helps protect normal salivary gland cells from the radiation's effects.