Oncology & Hematology Coding Alert

Question: Our physician prescribed oral chlorpromazine to a patient who presented for chemotherapy. How can we report this oral anti-emetic medication?

Illinois Subscriber

Answer: For an oral does given to a patient, report code Q0161 (Chlorpromazine hydrochloride, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen) for oral chlorpromazine. Report one unit of Q0161 for each 5 mg of chlorpromazine given.

Note the 48 hour dose regimen: The code Q0161 applies to 5 mg dose of chlorpromazine over a 48 hour period. The oral anti-emetic should be administered or prescribed by a physician for use immediately before, at, or within 48 hours after the time of administration of the chemotherapeutic agent.  

Meet this Medicare mandate: When you submit claims for chlorpromazine, verify the physician order indicates the beneficiary is receiving the oral antiemetic drug(s) as full therapeutic replacement for an intravenous anti-emetic drug as part of a cancer chemotherapeutic regimen.

Document the chemotherapy: You can report the oral anti-emetic drug(s) which are prescribed by your physician only on a per-chemotherapy-treatment basis. In this scenario, you report code Z51.11 (Encounter for antineoplastic chemotherapy) as your primary diagnosis code. This makes it clear the patient presented for chemotherapy.