Admission Solely vs Chiefly for Chemotherapy, Immunotherapy, and Radiation Therapy

For FY 2024, the Official Guidelines for Coding and Reporting of Neoplasms had a change that may impact coding of cases where patient is being admitted for chemotherapy, immunotherapy or radiation therapy.

In the below OCG for 2024, the word “chiefly” has replaced the word “solely” from FY2023. In the past coders looked for cases in which the patient was admitted for chemotherapy, immunotherapy or radiation therapy SOLELY. So, coders would not code Z51.11 or Z51.12 if the patient was also admitted for treatment of another condition.

However, for FY2024, CHIEFLY can impact the coder’s selection of the principal diagnosis as now Z51.11 or Z51.12 can be listed as the principal diagnosis even if the patient is admitted with another condition, as long as it is evident that the patient was admitted CHIEFLY for chemotherapy, immunotherapy or radiation therapy. In some cases, this may not be evident and a query will need to be issued to determine the chief intent of the admission.

FY 2024 OCG: NEOPLASMS

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 chiefly for administration of chemotherapy, immunotherapy and radiation therapy.

If a patient admission/encounter is chiefly 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. The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis. If a patient admission/encounter is for the insertion or implantation of radioactive elements (e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis. Code Z51.0 should not be assigned.

FY2023

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. The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis.

If a patient admission/encounter is for the insertion or implantation of radioactive elements (e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis. Code Z51.0 should not be assigned.

References

Official Guidelines for Coding and Reporting

Health Information Associates offers medical coding services, medical auditing services, and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities in the United States.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.