DX coding..

Patient comes into our office (hem/onc office) and we are seeing them for their primary dx of 185 (mal neoplasm of prostate). Patient comes in today for a sick call- fatigue and n/v. Normally I would audit the note and put the prim dx as fatigue, second dx n/v and third is the cancer dx. My question is- shouldn't we be putting their cancer dx (in this situtation) on the claim ALL the time regardless of the other "sick" dxs they are here for?

Part two-

Pt is recieving chemo, the particular drug that the patient is getting causes them to be B12 deficient, so they require B12 shots, we administer the B12 shot and we bill with dx code E933.1, shouldn't the second dx be the cancer dx? Also using the V07.39, shouldnt we have the cancer dx be second?

Documentation

Part II: Documentation must support the B12 injections. See codes 285.3 and 281.1.
The cancer diagnosis would be added as a secondary code when primary reason for the encounter was treatment of B12 deficiency.

Part I: The primary diagnosis assignment for OP visit is why they are being seen. If the focus is solely on N/V or fatigue, the cancer diagnosis would be secondary diagnosis assignment code. If the reason for the visit is overall care of the prostate cancer, the 185 is primary.

Best I can do based on information supplied.

dx coding...

Thanks for your response...

This is the situation...

We are giving a drug called Alimti this chemo drug will cause anemia, we originally were billing E933.1 for this and then came across some correspondence that referenced the V07.39 eff 2/1/10. The B12 shot is given prior to the Alimti so that they don't get or don't become extremely B12 deficient, so I am asking should we then use the E933.1, problem I am having is the B12 isn't a listed drug under this dx code in the book, so I am hesitant to use it, but there isn't a code elsewhere that has this listed either.

B12

http://mcgs.bcbsfl.com/?doc=Vitamin%20B-12%20Injections
An E code is never primary. Look at BCBS policy for covered diagnosis. Check individual payer policy
V07.8 may be choice when given for prophylactic reasons with CPT code for therapeutic injection.