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July 19, 2010

Coding for Chemotherapy Treatment
For The Record
Vol. 22 No. 13 P. 28

Chemotherapy uses powerful drugs in an attempt to eliminate cancer cells in the body. However, it also kills other fast-growing cells such as hair and blood cells, causing side effects such as hair loss and anemia.

It can be used alone, in combination with other chemotherapeutic drugs, or in combination with other treatments such as surgery and radiation therapy. It’s considered a systemic treatment since it can eliminate cancer cells at sites distant to the original site.

Common uses of chemotherapy include destroying or slowing cancer cell growth; as adjuvant therapy, which destroys hidden cancer cells that remain after another type of treatment; as neoadjuvant therapy, which shrinks a tumor to make other treatments possible; and palliative chemotherapy, which relieves signs and symptoms of advanced cancer, such as pain. It may also be used for nonneoplastic conditions such as bone marrow disease and immune system disorders.

Methods for administering chemotherapy include the following:

• Creams: typically used to treat skin cancer;

• Oral: requires swallowing pills or liquid;

• Intraperitoneal chemotherapy: an injection directly in the abdomen (54.97 + 99.25);

• Intrapleural chemotherapy (via thoracentesis): an injection directly into the chest cavity (34.91 + 99.25);

• Intrathecal chemotherapy: an injection into the spinal canal (03.92 + 99.25);

• Intravesical chemotherapy: an injection into the bladder (96.49 + 99.25);

• Implanting a chemotherapeutic agent: an interstitial, intracavitary, brain-wafer chemotherapy placed near a tumor during surgery, with the agent slowly breaking down to release the drugs (00.10); and

• Chemotherapy infusions (99.25): intravenous chemotherapy through a totally implantable vascular access device. (If the device is inserted during the current hospital episode, also assign code 86.07.)

The following is a summary of chemotherapy-related guidelines and may be found in the ICD-9-CM Official Guidelines for Coding and Reporting, effective October 1, 2009, pages 23-26:

Assign code V58.11, Encounter for antineoplastic chemotherapy, as the principal diagnosis if a patient is admitted solely for chemotherapy administration. Assign a code for the malignancy as the secondary diagnosis.

Sequence anemia as the principal diagnosis when the admission is for anemia management associated with the malignancy or the therapy and the treatment is directed at only the anemia. The anemia code assignment will depend on the specific type of anemia documented. Assign 285.22, Anemia in neoplastic disease, for anemia due to malignancy. Antineoplastic-chemotherapy-induced anemia is classified to 285.3. Do not use 285.22 for anemia due to chemotherapy. Also, it is unnecessary to assign E933.1, Antineoplastic and immunosuppressive drug, along with 285.3 since the adverse effect of chemotherapy information is included in the code title for 285.3.

Sequence dehydration as the principal diagnosis when the admission is for managing dehydration due to the malignancy or the therapy and only the dehydration is being treated.

Sequence the malignancy as the principal diagnosis when a patient is admitted for surgical removal of a malignancy followed by chemotherapy. If a patient is admitted only to receive chemotherapy, sequence code V58.11 as the principal diagnosis.

Sequence the malignancy (primary or secondary) as the principal diagnosis if a patient is admitted for staging the malignancy or a procedure such as thoracentesis even though chemotherapy may be administered.

If a patient is admitted with a nonneoplastic condition for chemotherapy, assign the condition as the principal diagnosis; do not assign V58.11.

Assign a code for the malignancy as either principal or secondary diagnosis depending on the circumstances of admission if a patient is receiving treatment for a malignancy that has already been excised. Do not assign a code from category V10, Personal history of malignant neoplasm, because the patient would not still be under treatment if the malignancy were actually a history of malignancy.

Coding and sequencing for chemotherapy treatment are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.