Wiki Diagnoses for Baseline Labs prior to beginning bioloigics

[kheimerman]

Hello All,
I am fairly new to Dermatology coding. We do a lot of treatment and prescribing of biologics for psoriasis. These are powerful drugs that can affect the organ systems negatively; therefore baseline laboratory tests are required prior to starting the patient on these medications. AFTER the patient has been on these meds, we continue to run lab tests to monitor if/how these medications are affecting the organ systems. Z79.899 usually works for monitoring (there are a few NCD/LCDs that do not cover with this code), but I'm wondering what ICD-10 code should be used for the initial baseline lab testing? We are not monitoring the patient's response to the medicine since they aren't on it yet, but simply getting a baseline. Many of these lab tests have NCDs and we're having trouble finding appropriate diagnosis codes? Thoughts anyone?

 

[CatchTheWind]

Hepatitis and TB testing for patients on biologics is an area in which the doctors and patients find themselves in a dilemma due to CMS's (and other payer's) unrealistic coding rules. On one hand, it is medically necessary to test patients; on the other hand, the code that's normally the most appropriate (Z79.899) is often not covered for the hepatitis testing. (It is usually covered for the TB.)

I would use Z79.899 if your carrier covers it, even for the baseline, because you are testing for the purpose of long-term drug use. Alternately, if the provider has any reason to think that the patient may have been exposed to hepatitis, you could use suspected exposure to hepatitis (Z20.5).

 

[kheimerman]

Baseline labs for Biologics

Thank you for your response! That is what this clinic has been doing, but I was concerned it didn't really fit the criteria. I appreciate the info.