2025 ICD-10-CM code Z51.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Encounter for antineoplastic chemotherapy and immunotherapy - Encounters for other specific health care (Z40-Z53) Factors influencing health status and contact with health services (Z00-Z99) Feed
This code signifies an encounter for antineoplastic chemotherapy and immunotherapy for a neoplasm.
Modifiers may apply to the accompanying procedural codes depending on the circumstances of administration (e.g., different sites of service, multiple procedures, etc.).
Medical necessity for Z51.1 is established through documentation supporting a diagnosis of malignancy and a treatment plan indicating that chemotherapy or immunotherapy is medically appropriate to treat the specific neoplasm.This typically involves pathology reports, imaging studies, and oncologist’s notes detailing the treatment strategy.
The clinical responsibility associated with this code lies with the oncologist or other qualified healthcare professional administering the chemotherapy and immunotherapy.This includes overseeing the treatment plan, monitoring the patient's response, and managing any adverse effects.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z51-Z51.9 Encounters for other aftercare
In simple words: This code is used when someone goes to the doctor or hospital to receive chemotherapy or immunotherapy treatment for cancer.The visit itself is coded, not the cancer diagnosis.
ICD-10-CM code Z51.1, "Encounter for antineoplastic chemotherapy and immunotherapy," is used to classify a patient's encounter with healthcare services specifically for the administration of chemotherapy and/or immunotherapy as part of cancer treatment.This code is applied when the primary reason for the encounter is the administration of these antineoplastic agents.It should be accompanied by a procedure code reflecting the chemotherapy or immunotherapy administered.The code excludes encounters for chemotherapy and immunotherapy for non-neoplastic conditions.
Example 1: A patient with metastatic breast cancer presents for their scheduled cycle of docetaxel chemotherapy. Z51.1 would be used to code the encounter for chemotherapy administration, along with a CPT code for the administration itself. , A patient with lymphoma receives a dose of rituximab, a monoclonal antibody therapy.Z51.1 would be used along with a procedure code specifying the administration of rituximab., A patient with advanced melanoma is receiving a combination of immunotherapy agents (ipilimumab and nivolumab). Z51.1 is utilized to code the encounter for immunotherapy along with appropriate procedure codes for the administration of the individual agents.
Documentation should include the diagnosis of neoplasm, the type and dosage of chemotherapy and/or immunotherapy administered, the date of administration, and any relevant clinical notes regarding the patient's response or adverse effects.Complete medical records and clinical documentation supporting medical necessity are essential for accurate coding.
** Always ensure accurate and complete documentation to support the use of this code.Improper use of this code can lead to claim denials.Verify payer-specific guidelines and requirements for appropriate reimbursement.
- Revenue Code: Revenue codes will vary depending on the specific services provided and the payer.
- RVU: RVUs are not directly associated with ICD-10 codes. RVUs are assigned to CPT codes for procedures and services provided and will vary based on the specific services rendered, geographic location, and payer.
- Global Days: Not applicable to ICD-10 codes. Global periods apply to surgical procedures coded with CPT codes.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier might apply to the procedural code depending on the circumstances of service provision.Refer to CMS guidelines for appropriate modifier use.
- Fee Schedule: Not applicable.ICD-10 codes are not associated with fee schedules. Fee schedules are linked to CPT and HCPCS procedure codes.
- Specialties:Oncology, Hematology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center