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Lisajeann

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Does anyone have any information on billing a Prostate Health Index (PHI) 84153, 84154 and 86316. We are billing all three codes with diagnosis R97.20. Medicare pays the 84153 and 84154 but not the 86316. They are denying it as not medically necessary. Can the 86316 only be billed with bladder/urinary symptoms??
 
Its not covered for those that are asymptomatic. H[FONT=&quot]ematuria & neoplasms, everything else not covered by medicare
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I only found one active LCD from Palmetto - L33420[FONT=&quot]
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[h=4]ICD-10-CM Codes that support Medical Necessity:[/h][FONT=&quot]C67.0 - Malignant neoplasm of trigone of bladder
C67.1 - Malignant neoplasm of dome of bladder
C67.2 - Malignant neoplasm of lateral wall of bladder
C67.3 - Malignant neoplasm of anterior wall of bladder
C67.4 - Malignant neoplasm of posterior wall of bladder
C67.5 - Malignant neoplasm of bladder neck
C67.6 - Malignant neoplasm of ureteric orifice
C67.7 - Malignant neoplasm of urachus
C67.8 - Malignant neoplasm of overlapping sites of bladder
C67.9 - Malignant neoplasm of bladder, unspecified
C7A.00 - Malignant carcinoid tumor of unspecified site
C7A.098 - Malignant carcinoid tumors of other sites
C7A.8 - Other malignant neuroendocrine tumors
C7B.00 - Secondary carcinoid tumors, unspecified site
C7B.09 - Secondary carcinoid tumors of other sites
C7B.8 - Other secondary neuroendocrine tumors
C78.00 - Secondary malignant neoplasm of unspecified lung
D09.0 - Carcinoma in situ of bladder
D41.4 - Neoplasm of uncertain behavior of bladder
D49.4 - Neoplasm of unspecified behavior of bladder
R31.0 - Gross hematuria
R31.1 - Benign essential microscopic hematuria
R31.21 - Asymptomatic microscopic hematuria
R31.29 - Other microscopic hematuria
R31.9 - Hematuria, unspecified
Z78.9* - Other specified health status
Z85.51* - Personal history of malignant neoplasm of bladder

R31.2 (before October 1, 2016) and R31.21 or R31.29 (effective October 1, 2016) are to be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.

Z78.9 To be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.

Z85.51 To be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.
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