Coding sequence

How should I code a visit on a UB for chemotherapy for metastatic ca. Per the LCD it states put the metastatic ca first with a V-code as secondary.

We coded like this v58.11, v58.12, 154.1 and 199.1. Does Medicare "care" about sequencing?

From LCD: Correct Coding requires the use of the secondary cancer code (196, 197, 198 and 199 series of ICD-9-CM codes) as the primary diagnosis and the original cancer site (V10 series of ICD-9-CM codes) as the secondary diagnosis. The secondary cancer sites will not be listed in the drug article, only the appropriate "History of", V10-codes are listed.

Coding sequence

I believe what the LCD wants is a secondary site code other than the 154.1 and 199.1 which are both primary sites.
Where are the metastatic sites?
E-mail me at andrea.coots@nortonhealthcare.org