Wiki Z51.12

[monica.evans@dchsystem.com]

If a patient comes in to our Cancer treatment center for a follow up to her metastatic breast cancer to the brain and during this visit received a phesgo injection does the Z51.12 code need to be added?
My question is because our physician did not document this information in his note, we just happened upon it during a review of the MAR. Is this going to be a compliance issue or is it ok since it is paid due to the secondary malignant neoplasm code. I am just confused as to when Z51.12 would have to be used? If they were only coming info for the injection?
Thank you for your help!
Monica

 

[kathleeng]

Z51.12 is to be assigned to encounters when patients are receiving immunotherapy. It looks like Phesgo is coming up as a chemotherapy drug so if so, in that case you would assign Z51.11. ICD-10 guidelines state to code Z51.11 primary along with the malignancy being treated as secondary. However, we have found that most payers in our area actually want the malignancy primary with the Z code secondary. We do receive denials if the Z code is not billed on the claim to support the encounter for the treatment.

Pertuzumab is the generic name for the trade name drug Perjeta™. Pertuzumab is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antineoplastic agent and a monoclonal antibody".
https://chemocare.com/chemotherapy/drug-info/Pertuzumab.aspx