Alicia: Oh, chemotherapy coding.
How exciting.
They actually had a question, I think, if you click on that first, I think there wasÖ
Iím having trouble with the sample test question.
Okay, it says, ìDr.
Aaron, an oncologist completed a consult for Sarah who has metastatic malignant melanoma
in the anterior stomach wall.
At this time, the primary site is unknown and the testing will continue during treatment.
Today, Sarah started chemotherapy.
Treatments with what diagnosis code would Dr. Aaron report for todayís treatment?î
Okay, scroll down.
The answer key is stating the correct answer is D. My questionerÖ ìConfusing is when
I see the coding guideline note under V58.11 where it states ëpatientís admission is
solely for the administration of chemotherapy, assign V58.00í which, by the way, thatís
not correct.
ëEncounter for radiation therapy or V58.11, etc.í Therefore, I would not have chosen
D because Sarah is starting chemotherapy treatments on this visit.
There was no mention of radiation.
I chose A because the coding guideline note.
How do I see this clear.
Okay so what I did was I broke it down.
ThereísÖ when you go to that section with the V codes for chemotherapy, thereís 3 main
types of treatment that youíre getting for your cancer when they come in.
The V codes isÖ if theyíre getting radiation which is V58.0, thatís where the person who
asked the question made the error.
V58.0 is actually for radiation therapy, not chemotherapy.
And then V58.11 is the encounter for antineoplastic chemotherapy and then V58.12 is the encounter
for antineoplastic immunotherapy.
So this code will be used first for every encounter, followed by the cancer code.
Iíll have to scroll down.
Even if the patient has a complication from the chemo in the guidelines state that the
V codes go first.
So when you read the guidelines that are around these codes, it tells you that the V code
goes first followed by cancer diagnosis then what the patient is suffering from.
Itís common for when the person has chemotherapy for them to get nausea and vomiting and dehydrated
after their chemotherapy.
So when a patient is admitted for chemotherapy and then develops one of these complications,
you still code the therapy first.
So keep that in mind.
Your V codes are always going to go first.
So we have an example where a patient whoís admitted for chemotherapy, for plasma cell
leukemia.
Itís going to be V58.11 because theyíre getting chemotherapy, not radiation or that
immunotherapy and their cancerís coded 203.10.
Now our next person, Betty, was admitted for chemotherapy for giant cell leukemia and after
her treatment was finished, she developed nausea and vomiting that was not relieved.
So she was treated for the nausea and vomiting.
So for that encounter, youíre going to still do the V58.11.
Even though she had the nausea and vomiting, itís still V58.11.
The cancerís 207.20 and then the nausea and vomiting is 787.01.
So thereís no reason ever not to put that V code first.
Now some people donít know what these terms were so I pulled these off from Find the Code
that has the definitions of them.
AntineoplasticÖ what that just means is that theyíre giving youÖ thatís a medication
thatís used to take care of the malignant cells.
And then the chemotherapy, the definition for that isÖ oh, itís on the next page of
it because it was so big.
The treatment of disease by chemical agents originally applied to use of chemicals that
affected the caustic organism unfavorably but do not harm the patient.
And of course, they usually just say chemo.
You wonít see chemotherapy but it is a therapy that theyíre doing.
So if you go back to his questionÖ oh no, are we able to go back?
HeísÖ if you just eyeball that real quick, she got chemotherapy.
So it would be V58.11 because we know that chemotherapy is what they got and thatís
the code, V58.11 and it goes first.
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