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Help with chemo port coding op note

Can someone experienced with this type of coding please assist, as this is a whole new ball-game for me. MCR pat w/dx rectal cancer. I extracted the pertinent info & abbreviated from chart note to ease in assistance.
Summary:
* Access type: Left Other AVF/AVG.
* Subclavian vein: temporary dialysis catheter insertion.
Radiation Totals:
Total fluoro time: 1.0 min:sec
Technique:
——The R upper extremity and L upper extremity were prepped using Chloraprep R and L neck, chest to nipple line. Local/MAC sedation administered by CRNA services administered w/trained independent observer in attendance to monitor level of consciousness & physiological status. The subclavian vein was accessed in an antegrade fashion from L. After carefully reviewing the diagnostic fistulogram, it was decided to proceed w/intervention. Sheath was removed & upsized for 8-Fr sheath.
Intervention:
A catheter was placed over the wire in the subclavian vein. Temporary dialysis catheter insertion is positioned in the vessel. MedCOMP CT Implantable Port – REF #L MRDP80AMN 8 fr. 61cm MS Dignity CT Port Lot #: MNDM230 Exp. 07/31/2023 implanted into L chest via L Subclavian Vein.
The puncture site was closed using Incision site to L chest closed w/Dermabond.
Findings: Subclavian vein: normal.

I’m thinking 36561 and 77001 would be appropriate. Doctor listed 36299 (unlisted) for vascular injection.
Validation/correction would be appreciated.

Medical Billing and Coding Forum

mal-positioned chemo port with revision

Can someone take a look at this and offer some suggestions as to CPT code? Utilizing the index I find 36597 but this does not describe what was done, and no mention
of fluoroscopy. I’m totally puzzled and it probably is easier than I am making it.
Revision of l. internal jugular vein chemo port:
"local aneshtetic was infiltrated into skin overlying the port access pocket. Pocket was opened. The port was noted to be flipped w/hard plastic backing closest to skin.
Port was then secured in place in its intended position w/interrupted 3-0 Prolene suture. Port pocket was then closed w/running 4-0 Monocryl & Dermabond."

Medical Billing and Coding Forum

use of HCPCS code Q0163 when it’s not chemo related?

I’m coding for urgent care and the providers often give oral Diphenhydramine HCL to handle other symptoms that are nothing to do with chemo. Web MD lists all kinds of uses for the drug, non of which are chemo related specifically, yet the only oral HCPCS code for the drug specifically states for use at the time of chemo treatment. (Q0163)

Does anyone know if I can use this code even when not related to chemo or do I have to use the J8499 – prescription drug, oral, non-chemo, NOS? (or some other HCPCS code I may be missing)
Thank you.

Medical Billing and Coding Forum

inpt chemo treatment

I’m newer to coding oncology, I was trained briefly before the last person covering the division left. If a patient is admitted to the hospital for chemo treatment and they did the treatment and the doctor noted that they completed their course of chemo treatment on a certain date…the primary diagnosis for those days of chemo treatment are Z51.11…NOW the patient stays in the hospital for monitoring and count recovery for several days after do I still code the Z51.11 as primary diagnosis for all those days even though she is no longer having chemo treatment but it’s related to that OR do I now just code for the cancer as primary and any additional diagnosis?

Medical Billing and Coding Forum

Z01.818 for E/M visits prior to chemo treatment

We are trying to get more information on using Z01.818 for office visits for patients prior to chemo treatments as they evaluate the effects of chemo on the patient and whether they can continue with their treatment on that day or not. Of course, if no treatment is given, this code cannot be used. These office visits are usually a level 3 or 4, sometimes a 5. We know that the chemo admin code has a low level inherent E/M included. One of the descriptions we found for Z01.818 is "an encounter for examination prior to antineoplastic chemotherapy".

Does anyone use this code? Are there issues with denials and/or certain payers? What is the criteria you use to use this dx?

Thank you.

Medical Billing and Coding Forum

Coding Labs for recurring testing on chemo patients

My physician orders a recurring Labs of CBC, CMP, TSH on his active chemo patients to monitor their blood levels. The pt usually goes for blood work 2 days before the chemo and the physician decides the next chemo session based on the lab results. Can I use Z51.81 +Z79.899 or just Z79.899 along with malignancy code on the lab orders? We are getting a lot of 84443, TSH denials? Not all the pts are diagnosed with Hypo or hyper thyroid. Thank you!

Medical Billing and Coding Forum