Encounter for chemotherapy
When a patient is admitted for chemo, the official coding rules state that Z51.12 should be sequenced as the primary diagnosis. When a patient is stable at the time of admit, this rule seems straightforward. When a patient is admitted for chemo and is also experiencing symptoms related to the cancer (i.e. ascites, confusion) how do you select the principal diagnosis? The rules states when the encounter is "SOLELY" for chemo to use the Z code for encounter for chemo. In the context of this rule, I interpret this to mean that the patient did not receive any other treatments such as surgery or radiation but was solely treated with the chemotherapy.
When a patient is admitted for Chemotx and is also experiencing other conditions that might warrant admission, would it be appropriate to sequence either the encounter for chemo or any condition that met the definition of principal diagnosis (reason for admission after a course of study)? Or do other conditions that co-exist mean that you can no longer use Z51.12 as primary since it was not solely the reason for the admission?
e. Admissions/Encounters involving chemotherapy, immunotherapy and radiation therapy 1) Episode of care involves surgical removal of neoplasm
When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by adjunct chemotherapy or radiation treatment during the same episode of care, the code for the neoplasm should be assigned as principal or first-listed diagnosis.
2) Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy 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.
Comments
BUT, if there are efforts to determine the extent of the cancer or for a definitive procedure used to treat or stage the cancer, such as paracentesis or thoracentesis, the cancer is the principal diagnosis.
There are some helpful scenarios in Coding Clinic that are too voluminous to paste here.
Paul
Thank you Paul. Could you comment on this scenario?
Patient with known colon cancer with mets to the liver, recently had surgery to resect the tumor. Patient noted to have increased jaundice and ascites. MD notes the cancer is advancing quickly and there is an urgent need to admit the patient to start chemo (palliative not curative). During the admission, in addition to chemo tx, patient receives treatment for cancer symptoms such as the ascites and has a therapeutic paracentisis. No work up is done to determine the stage or extent of the cancer. Can the Z-code for encounter for chemo be the pdx when we also treated the ascites?
Ellen
The guidelines state that when the encounter is to determine the extent of the malignancy, or for a procedure such as paracentesis or thoracentesis the malignancy is the PDX. I am paraphrasing from memory. In the scenario you describe the chemo can't be the PDX because a therapeutic paracentesis was performed.
Paul
Paul - Okay got it. So in my scenario above, if the patient did NOT have a procedure like a paracentisis, but still had ascites and jaundice on admit, the Z-code for encounter for chemo could be the pdx? For instance, say the patient had weakness and anemia that we treated during the encounter for chemo - but no procedure.
Be warned....now that I discovered this discussion page, I may be a regular... I have lots of questions...lol
The rules’ for neoplasms are particular nuanced; so, be forewarned the coding in the arena of neoplasms is complex. The coding conventions are over 100 pages long, and well, you get the idea.
So, I am averse to state something like ‘always’ if I respond with an opinion on a complicated coding topic. Hope you understand.
At any rate, Your site coders ‘should’ have a good handle on sequencing of neoplasms, particularly when chemotherapeutic efforts are provided in conjunction with other treatments.
But, basically, if and when a patient with a KNOWN cancer is admitted SOLELY for chemo, then the chemo is the PDX. (Tip: watch for panyctopenia after chemo). Hope this helps a little. I have been doing CDI solely for a decade and I no longer consider myself an ‘expert’ on coding. Just know enough to work as a CDI.
Paul Evans, RHIA, CCDS