Urology Coding Alert

Question: When should I start using "history of" diagnosis codes if the patient has been treated for a cancer? Is there a time frame? And do I get paid when I just use the V codes on procedures such as a cystoscopy?

Wisconsin Subscriber

Answer: Remember that time elements are only for clinical aspects of a disease, but for coding purposes if a patient has no clinical (history, physical or laboratory) evidence of the presence of the recently treated carcinoma, you may then use the V codes for "history of." If your urologist continues to treat a patient for his tumor even if the treatment is prophylactic, you should always bill the tumor diagnosis first.

Exception: The one exception to this rule is for prostate cancer where you may use V10.46 (Personal history of malignant neoplasm; prostate) when your physician is treating a patient with a luteinizing hormone-releasing hormone (LHRH) analog drug when the physician considers the patient surgically or radiologically cured based on the above coding criteria.

Remember: Not all carriers will accept V codes as primary or first diagnoses at all. So when in doubt about whether you can use V codes and get paid for a procedure, consult with the individual carrier.