Oncology & Hematology Coding Alert
Establish Cause for Screening Breast MRI
Question: Does Medicare pay for a screening breast MRI? Our physician is scheduling a breast MRI in a BRCA2 positive patient.
Delaware Subscriber
Answer: You should confirm with Medicare if they cover the diagnosis V84.01 (Genetic susceptibility to malignant neoplasm of breast) in support of medical need.
At the present time, they will not pay for a screening breast MRI, so you have to establish that this is not screening. However, you cannot use a non-V code because the patient currently apparently does not have an issue except for her BRCA status (unless she found a breast lump or something).
Another option is using a 795.8x code if you also have an abnormal tumor marker such as an elevated CA-15, ER status, etc. The BRCA test finds a gene that may increase the risk of cancer but is not a tumor marker.
ICD-10: When you shift to ICD-10, you will report Z15.01 (Genetic susceptibility to malignant neoplasm of breast) instead. If the patient had an elevated CA-15, code 795.89 (Other abnormal tumor markers) becomes R97.8 (Other abnormal tumor markers).
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Establish Cause for Screening Breast MRI
Question: Does Medicare pay for a screening breast MRI? Our physician is scheduling a breast MRI [...]
