Reporting follow-up office visits for chemotherapy treatment with ICD-10-CM

The International Classification of Diseases, 10th revision, Clinical Modification, medical code set will become effective with dates of service on or after Oct. 1, 2015. As a result, some changes in reporting diagnosis codes will be needed due to differences between the ICD-9-CM and ICD-10-CM code set.

These code set differences will also affect reporting follow-up visits for monitoring a course of chemotherapy. Currently, there isn’t a unique code in ICD-10-CM to report a follow-up visit during a course of chemotherapy. In these instances, follow the ICD-10-CM Official Guidelines for Coding and Reporting. You can access the document by clicking here.

Here are two examples that may apply:

• Official coding guidelines state when the patient admission or encounter is only for administration of chemotherapy (immunotherapy or radiation therapy), assign the applicable code from category Z51 for other aftercare as the first listed or principal diagnosis. The malignancy that the therapy is being administered for should be assigned as a secondary diagnosis. When a follow-up visit is performed on the same day that the next course of chemotherapy is administered, these guidelines will apply. The code Z51.11 represents encounter for antineoplastic chemotherapy. Use of this code will establish that the patient is receiving a course of chemotherapy.
  
  Example:

• Code: Z51.11 – Encounter for antineoplastic chemotherapy
• Code: For malignancy

• Official coding guidelines state that when the patient admission or encounter is for the management of anemia associated with an adverse effect of the administration of chemotherapy (or immunotherapy), and the treatment is only for the anemia, the anemia code is listed first, followed by the appropriate codes for the neoplasm and the adverse effect. Other blood disorders, such as pancytopenia or agranulocytosis, which are due antineoplastic chemotherapy, also apply to this guideline.
  
  Example:

• Code: D64.81 – Anemia due to antineoplastic chemotherapy
• Code: For malignancy
• Code: For adverse effect of antineoplastic and immunosuppressive drugs

CPT and HCPCS Level II codes are not changing. You can continue to report the applicable procedure codes and continue to follow guidelines for those code sets.

If you have any questions, email ICD-10providerreadiness@bcbsm.com.