Wiki Advise

[jlb102780]

Needing some advise

I had a report for an ABI, the physician indication was Peripheral Vascular Disease. There was no mention of the patient having a prior history of this and the test came back completely normal. I went to the order to see what this test was originally ordered for and it stated Leg Pain. No other symptoms were dictated. I billed the claim out with dx 729.5

There is a little debate going on with this claim. I have 1 person stating that PVD should have been used due to the dr listing that as the indication for the study. I'm having a hard time agreeing with this due to the fact that the test did not show this and there is nothing in the history of the patient stating this either.

 

[koatsj]

I agree with you. If there is no prior history of PVD and the ABI was completely normal, I would bill the 729.5 which will probably be denied unfortunately. I go through this all the time with my general surgeons. PCP's order them because of leg pain and the studies are typically normal. Sometimes "claudication" will be listed as the reason for the study but the patient really only has leg pain. It's very frustrating.

 

[jlb102780]

I agree with you. If there is no prior history of PVD and the ABI was completely normal, I would bill the 729.5 which will probably be denied unfortunately. I go through this all the time with my general surgeons. PCP's order them because of leg pain and the studies are typically normal. Sometimes "claudication" will be listed as the reason for the study but the patient really only has leg pain. It's very frustrating.

I agree, its very frustrating. Thanks so much for your insight. Happy Friday

 

[mitchellde]

You might try looking at a V71 code for condition not found as the first listed code then using the 729.5 as a secondary. I have found this to be successful in the past.

 

[rryder1963]

Why the debate?

If the doctor ordered the test indicating 729.5 as the dx, could it be that the pt had leg pain on that particular day regardless of h/her history?

From how I am reading your inquiry, the provider was trying to rule out PVD. In such a case, dx codes for conditions providers are trying to rule out or suspect a patient may have, cannot be assigned as a reason for testing in an outpatient setting as per ICD-9 coding and Medicare guidelines-only the presenting signs and symptoms.