Oncology & Hematology Coding Alert

Question: Our practice sometimes performs EKGs on patients taking chemo drugs that can affect the heart. What diagnosis codes should we use for these EKGs?

Idaho Subscriber

Answer: If the EKG results are normal, you should report a -special screening- V code for the diagnosis. Depending on your documentation, report one of the following codes:

-  V81.0 -- Special screening for ischemic heart disease

-  V81.1 -- Special screening for hypertension

-  V81.2 -- Special screening for other and unspecified cardiovascular conditions.

Snag: Most payers won't cover the cost of a screening exam. If your carrier won't reimburse you for a screening, you may need to obtain an advance beneficiary notice (ABN) from the patient. Ask the patient to sign this form, which says he agrees to pay for the test if Medicare won-t. Some private payers offer similar waivers.

Try this: Some payers will reimburse you for heart studies if you include one of the following:

- V58.11 -- Encounter for antineoplastic chemotherapy

- V58.42 -- Aftercare following surgery for neoplasm

- V58.69 -- Long-term (current) use of other medications

- V58.83 -- Encounter for therapeutic drug monitoring

- V66.2 -- Convalescence and palliative care; following chemotherapy

- V67.2 -- Follow-up examination; following chemotherapy.

Note: If the patient does have a documented heart condition, you may report the diagnosis code for that condition. Report EKG findings with secondary diagnosis codes.