Resolved Inpatient Chemo Encounter

[MariaE_80361]

The patient presented for hospital admission for scheduled chemotherapy. During admission progress, the patient complained of leg swelling that started the previous day but decided to still come in for chemo. The patient had an Ultrasound during admission and was given lovenox for left popliteal vein DVT and the patient received chemotherapy treatment as well. Given this scenario would it still be appropriate to use Z5111 encounter chemotherapy? or would the cancer diagnosis be?

 

[Darcy]

"The reason for the encounter" is the driving question when choosing first listed dx. She was admitted for the chemo tx so that should be the primary dx followed by the CA dx and the DVT

 

[Alicia]

I see why this is can be confusing. What will determine is based on patient status.
1. was the pt "Inpatient" or "Outpatient"?
The orders for the Tx is going to be key.
First listed dx is the reason that prompts the visit.
Chemo, Cancer, DVT -25

 

[MariaE_80361]

This is in the inpatient setting. What is causing the confusion is the word solely in the guideline. I.C.2.e.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.

Many coder in our department feel that cancer should be coded first as the admission is no longer solely for chemo.

 

[Alicia]

That would be correct. However the intent of the visit was for the Chemo. That is where -25 comes in. It explains why more work was done besides the chemo.

 

[Alicia]

On another note. You can do it either way and still be good. Be very clear that two things were provided Chemo and Tx for DVT. Thus -25.