Admission for Chemo ---Sharing answer from Coding Clinic
I submitted this to Coding Clinic a while back due to the number of denials we were getting from the payor refusing to budge: " We are receiving denials for Z51.11 as principal diagnosis when the patient has a planned, elective admission for chemotherapy and after admitted, initiation of therapy is delayed due to complaints of fatigue, subjective fevers, or anemia, etc."
This is their response:
This is their response:
May 29, 2019
Rebecca Willcutt
Director CDIP
Cooper University Hospital
2544 Magnolia Place
Birmingham, AL 35242
Dear Ms. Willcutt,
This letter is in response to your request for clarification regarding code assignment when a patient is admitted for chemotherapy and is unable to receive the treatment.
Assign code Z51.11, Encounter for antineoplastic chemotherapy, as the principal diagnosis for the admission. Although the patient did not receive the chemotherapy, this was the reason for the admission. Assign also the appropriate code(s) for the documented conditions that meet reporting requirements (for example, fatigue, subjective fevers, or anemia, etc.) as well as code Z53.09, Procedure or treatment not carried out because of other contraindication.
I trust this information will be of assistance to you.
Sincerely,
Diane Komar
Diane Komar, RHIT
Coding Consultant
Ref. #50028579.1018
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