Primary Care Coding Alert

Question: Does anyone know the correct ICD-9 code for a screening duplex for an abdominal aortic aneurysm? It is supposed to be covered as a screening test for males on Medicare and is recommended by the US Preventive Services Task Force. I got a call back from the local hospital that I need to give them an ICD-9 code for an actual aneurysm, which I can not do because it is not true, so the test never gets done.

Tennessee Subscriber

Answer: There is no ICD-9 code specific to screening for abdominal aortic aneurysm (AAA). However, you can keep future claims clean by following the rules available at Medicare's Web site: www.cms.hhs.gov/transmittals/downloads/R1113CP.pdf.

For example, for Medicare to cover the code, the patient must meet one of the following risk categories:

• Has a family history of AAA

• Is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime

• Is a beneficiary who manifests other specified risk factors recommended for screening by the United States Preventive Services Task Force (USPSTF) regarding AAA, as specified by the Secretary of Health and Human Services, through the national coverage determination process.

Furthermore, the USPSTF recommendations are the following:

• One-time screening for AAA by ultrasonography in men aged 65 to 75 who have ever smoked.

• The USPSTF makes no recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked.

• The USPSTF recommends against routine screening for AAA in women.

Because there is no specific ICD-9 code for AAA screening, you will need to use a non-specific screening code. For example, consider using V81.2 (Special screening for cardiovascular, respiratory, and genitourinary diseases; other and unspecified cardiovascular conditions) as the primary diagnosis, and, as appropriate, use V15.82 (History of tobacco use) as a secondary diagnosis for patients age 65 to 75 who has smoked at least 100 cigarettes in his lifetime.