Wiki Personal history of malignant neoplasm

[Tonyj]

I was informed that insurance companies are not paying for V codes used as primary diagnoses for history of malignant neoplasms. Pt is coming in for follow up to cancer for observation only. Is anyone else having this issue? If so how are you dealing with it?

 

[mitchellde]

V codes for history of neoplasm are allowable first listed. A payer cannot deny a claim just because you use a V code. What are you linking the V code to? Perhaps it is the CPT code that is the problem. Or perhaps you need a V67.x code for follow up as well as the hx of neoplasm code. I have never had an issue with using a V code for hx of with an E&M code.

 

[Tonyj]

V codes for history of neoplasm are allowable first listed. A payer cannot deny a claim just because you use a V code. What are you linking the V code to? Perhaps it is the CPT code that is the problem. Or perhaps you need a V67.x code for follow up as well as the hx of neoplasm code. I have never had an issue with using a V code for hx of with an E&M code.

It's listed for the E/M. I agree, I don't see why they would deny. I'll have to research further. Thanks for responding.

 

[kivbar16]

How long ago was the cancer dx? I was taught to use the code for current cancer for the first 5 yrs following successful treatment. After that it becomes a history code.

 

[mitchellde]

How long ago was the cancer dx? I was taught to use the code for current cancer for the first 5 yrs following successful treatment. After that it becomes a history code.

I am not sure where you heard that but there is no basis for that logic. The cancer is history of when all treatment is over and the provider indicates there is no evidence of disease. There is no wait time involved. Breast cancer is different, if it is still being treated with Tamoxifen or any equivalent drug, then the cancer is still being treated even though the provider may indicate no evidence of disease, also prostate cancer if it is still being treated with drug therapy.