Oncology & Hematology Coding Alert

Question: How should we code for an initial visit for a patient referred to us for colon cancer screening? We tried 99241(office consultation) with V76.49 (other sites) but were denied.

Nebraska Subscriber
 
Answer: Code 99241 is used most frequently for documentation of an office consultation for a new or established patient. But the physician must perform a problem-focused history and examination with basic and clear-cut medical decision-making. Usually, the patient presents with a problem or set of problems -- the chief complaint -- which is one of the most important elements of coding appropriately and capturing correct payment.
 
Even though another physician referred the patient, the reason for the cancer screening must be documented to code correctly. For example, a complaint of rectal bleeding may include one of the following diagnosis codes to indicate symptoms that would warrant a diagnostic colon cancer screening: 578.9 (bleeding from the bowel), 569.3 (bleeding from the rectal sphincter) or 459.1 (postphlebitic syndrome). (Code 459.1 requires documentation in the patient record that no loss of consciousness occurred.)
 
The reason V76.49 was denied could be that the diagnosis code specifies "other sites" in a special screening for malignant neoplasms. This is a nonspecific code that is usually denied. If the patient stated that he or she had noticed either "black stools,"  "rectal bleeding" or "some blood in the toilet," you would use V76.41 (rectum) because this describes a specific site, a detail that payers want to see.
 
You have several coding options:
 
1. Report 99241. The doctor should write or dictate a clear report of the services he or she wishes to screen for. The patient record should include whether a rectal exam was performed, and a patient history. If these are not documented, the practice risks getting denied.
 
2. Report 82270 (blood, occult, by peroxidase activity [e.g., guaiac]; feces, 1-3 simultaneous determinations). This laboratory test code should be billed in groups of three slides. If the patient comes in three times, 82270 should be billed each time.
 
3. Report only one date of service (DOS) for each group of slides (three visits with slides for three dates).
 
4. Report G0107 (colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations). This should be billed in groups of three slides and with only one DOS per group of slides.
 
This code grouping should yield $28 to $95 depending on the payer, national location, follow-up and documentation. And if the oncologist is the provider who must explain the test results to the patient, you can report a follow-up office visit, such as 99212 (office or other  outpatient visit).