Wiki 96402 and other Admins codes..use cancer dx or Encounter for antineopastic chemotherapy

[ruthan]

Good Morning,
We have been getting denials recently from Adv Plus Blue in Michigan. We have always used the cancer diagnosis as primary with the 96402 and also on other Administration codes. All of a sudden we are getting denials not always consistent but stating that the diagnosis code used (which is the cancer codes) is invalid, it now appears they want a Z51. etc code as primary for these.. There are way to many policies to keep track of do I use the cancer code for this or the Z51 code. Does anybody have any thoughts. Thanks for your time

 

[sls314]

Good Morning,
We have been getting denials recently from Adv Plus Blue in Michigan. We have always used the cancer diagnosis as primary with the 96402 and also on other Administration codes. All of a sudden we are getting denials not always consistent but stating that the diagnosis code used (which is the cancer codes) is invalid, it now appears they want a Z51. etc code as primary for these.. There are way to many policies to keep track of do I use the cancer code for this or the Z51 code. Does anybody have any thoughts. Thanks for your time

That's straight from the ICD-10-CM guidelines. You should always be using the Z51 code if the purpose of the encounter is to administer chemotherapy. Payers are getting savvier on following the guidelines now. If you're not using this code regularly now, you may want to start or you could get push back from other payers down the road too.

I.C.2.e.2

If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or external beam radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence.