EmailACS 0044 Chemotherapy
Publication Date: March 2006
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 2101
We are having difficulty applying ACS 0044 'Chemotherapy' for patients with neoplasms who are admitted to our same day oncology ward. In particular we are having difficulty determining what a ‘neoplasm related condition’ is. How should the following scenarios be coded?
1. Patient is admitted as a same day episode to our day oncology ward with dehydration and receives intravenous electrolytes. Patient has previously been diagnosed with breast cancer. Is the PD Z51.1 or E86? What is the correct procedure code to assign 96199-00 or 96199-08?
2. Patient admitted as a same day episode to our day oncology ward for IV erythrypoietin (a hormone that increases red blood cell production) to treat anaemia. Pt has previously been diagnosed with a neoplasm. Is the PD Z51.1 or neoplasm code followed by D63.0? What is the correct procedure code to assign 96199-00 or 96199-09?
3. If a patient who has a neoplasm is admitted to our day chemotherapy unit for electrolytes to treat nausea and vomiting, we don’t know whether the nausea and vomiting are neoplasm related conditions or not. If the documentation does not support or rule that a condition is a “neoplasm related condition”, how should the episode be coded? Do we assume the condition is a neoplasm related condition or assume that it’s not a neoplasm related condition?
1. Patient is admitted as a same day episode to our day oncology ward with dehydration and receives intravenous electrolytes. Patient has previously been diagnosed with breast cancer. Is the PD Z51.1 or E86? What is the correct procedure code to assign 96199-00 or 96199-08?
2. Patient admitted as a same day episode to our day oncology ward for IV erythrypoietin (a hormone that increases red blood cell production) to treat anaemia. Pt has previously been diagnosed with a neoplasm. Is the PD Z51.1 or neoplasm code followed by D63.0? What is the correct procedure code to assign 96199-00 or 96199-09?
3. If a patient who has a neoplasm is admitted to our day chemotherapy unit for electrolytes to treat nausea and vomiting, we don’t know whether the nausea and vomiting are neoplasm related conditions or not. If the documentation does not support or rule that a condition is a “neoplasm related condition”, how should the episode be coded? Do we assume the condition is a neoplasm related condition or assume that it’s not a neoplasm related condition?
Response
A condition should not be assumed to be a neoplasm related condition unless documented as such or classified as such by coding convention, index entry or ACS.
The NCCH provided the following advice:
NCCH suggests that a condition should not be assumed to be a neoplasm related condition unless documented or classified as such.
Assign the following codes for the scenarios cited:
1. E86 Volume depletion (for the dehydration, as the principal diagnosis)
A code for the breast cancer (if the breast cancer is a comorbidity that has an affect on the episode of care as per ACS 0002 Additional Diagnoses) see also ACS 0236 Neoplasm Coding And Sequencing
96199-08 [1920] Intravenous administration of pharmacological agent, electrolyte (as the principal treatment in same-day episodes of care)
2. The dagger (aetiology)/asterisk (manifestation) multiple code assignment for anaemia in neoplastic conditions indicates that the anaemia is a neoplasm related condition.
Z51.1 Pharmacotherapy session for neoplasm
A neoplasm code (dagger)
D63.0* Anaemia in neoplastic disease
96199-00 [1920] Intravenous administration of pharmacological agent, antineoplastic agent (as the principal treatment in same-day episodes of care)
3. R11 Nausea and vomiting
A neoplasm code (if the neoplasm is a comorbidity that has an affect on the episode of care as per ACS 0002 Additional Diagnoses) see also ACS 0236 Neoplasm Coding And Sequencing
96199-08 [1920] Intravenous administration of pharmacological agent, electrolyte (as the principal treatment in same-day episodes of care).
The NCCH provided the following advice:
NCCH suggests that a condition should not be assumed to be a neoplasm related condition unless documented or classified as such.
Assign the following codes for the scenarios cited:
1. E86 Volume depletion (for the dehydration, as the principal diagnosis)
A code for the breast cancer (if the breast cancer is a comorbidity that has an affect on the episode of care as per ACS 0002 Additional Diagnoses) see also ACS 0236 Neoplasm Coding And Sequencing
96199-08 [1920] Intravenous administration of pharmacological agent, electrolyte (as the principal treatment in same-day episodes of care)
2. The dagger (aetiology)/asterisk (manifestation) multiple code assignment for anaemia in neoplastic conditions indicates that the anaemia is a neoplasm related condition.
Z51.1 Pharmacotherapy session for neoplasm
A neoplasm code (dagger)
D63.0* Anaemia in neoplastic disease
96199-00 [1920] Intravenous administration of pharmacological agent, antineoplastic agent (as the principal treatment in same-day episodes of care)
3. R11 Nausea and vomiting
A neoplasm code (if the neoplasm is a comorbidity that has an affect on the episode of care as per ACS 0002 Additional Diagnoses) see also ACS 0236 Neoplasm Coding And Sequencing
96199-08 [1920] Intravenous administration of pharmacological agent, electrolyte (as the principal treatment in same-day episodes of care).
