Oncology & Hematology Coding Alert

Question: Which diagnosis code should we use when we perform ECGs on asymptomatic patients to monitor the affect of chemotherapy on their hearts, and the results are normal?

Wisconsin Subscriber

Answer: When the patient is asymptomatic, you should report "special screening" V code, V81.x (Special screening for cardiovascular, respiratory, and genitourinary disease ...).

Choose the fourth character based on the documentation:

• V81.0 -- ... ischemic heart disease
• V81.1 -- ... hypertension
• V81.2 -- ... other and unspecified cardiovascular conditions.

Watch for: Some payers may not reimburse a screening exam. If you expect that your payer won't reimburse you for a screening, consider obtaining an advance beneficiary notice (ABN) for Medicare patients, or similar waiver for non-Medicare patients, in which the patient agrees to cover the cost of the test if the payer won't. For Medicare, remember to append the appropriate modifier to the procedure code to indicate you have the ABN on file. For more on ABN modifiers, visit www.cms.gov/MLNMattersArticles/downloads/MM6563.pdf.

Helpful: An additional code, such as one of the following, may help support payment for this screening exam:

• 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.

But remember to report codes only if your documentation supports their use.

Special note: If the patient is enrolled in a clinical trial where the ECG is part of the trial for data collection and monitoring the patient's health status, special modifiers and reporting instructions may apply. Be sure to reference the CMS clinical trial policies on the CMS website at www.cms.gov/ClinicalTrialPolicies/.