Oncology Coding Article – Outpatient Prospective Payment System (OPPS)


Medical Oncology Code Changes

ACOA’s Coding Corner – November 2005

New Diagnosis Codes Explained

Effective October 1, 2005 diagnosis code V58.1 requires a 5th digit to be considered complete:

V58.11 – Encounter for antineoplastic chemotherapy

V58.12 – Encounter for antineoplastic immunotherapy

According to the Official ICD-9-CM Diagnosis Coding Guidelines, a patient admitted for radiotherapy, chemotherapy, or immunotherapy is assigned a V code (V58.0, V58.11 or V58.12) as the primary diagnosis.  The cancer, disease, or condition is reported as a secondary diagnosis.  When procedures V58.0 (encounter for radiotherapy) and V58.11 or V58.12 are performed simultaneously, both may be reported on the same record, with either one sequenced first.

The difference: Immunotherapy stimulates the body’s own immune defense system to fight infection and disease, and chemotherapy attacks cancer cells themselves.  What is essential to understand is that these V codes are primarily used for tracking purposes, and do not affect reimbursement.  Examples of immunotherapy include Bacille Calmette-Guerin (BCG), interferon-alfa (IFN-alfa), interleukin-2 (IL-2), and other monoclonal antibodies.”

While these codes are defined as ‘primary’ codes by the ICD-9-CM Manual, additional diagnosis codes are reported to define the location of the malignancy or other condition under treatment, as well as diagnosis codes for signs and symptoms (i.e., nausea, fatigue, pain, etc.).  This combination of diagnosis codes provides a complete picture of the individual patient treatment provided.

Watch for more 2005 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates.

This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.

Phone: (877) 6CODING

Fax: (770) 445-0407

[email protected]

Cindy C. Parman, CPC, CPC-Hcparman-9514376
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.