Wiki Secondary Diagnosis

[tracefurious]

So for the Trailblazer states (CO, NM) we have an LCD for b-12 and folate.
V58.69 is an acceptable diagnosis code however it can only be used as secondary. If I were to bill these test with a primary diagnosis code that is not medically necessary, but use the medically necessary V58.69 as secondary will I still get paid for these tests?
Example:
82607 285.9 V58.69

 

[mitchellde]

If the test is being performed because the patient is on the drug then the appropriate first-list dx code is V58.83 encounter for therapeutic drug monitoring, then the V58,69, the 285.9

 

[tracefurious]

No the test isn't because of the encounter. It is just a diagnosis a lot of our facilities give us, however if it were the encounter is not medically necessary when the longterm med is would I still get paid?

 

[mitchellde]

I am not sure I understand the issue. Are you wanting the dx codes for a lab test because the patient is taking B12? or something else?
The appropriate codes for the test are the V58.83 with the V58.69 there are several coding clinics regarding this and you should have no problem with the payment.

 

[tracefurious]

For this particular example. The pt has anemia 285.9 but trailblazer will deny because of lack of medical necessity.. I want to bill the primary 285.9 and secondary V58.69. V58.69 is considered medically necessary by trailblazer.. I wanted to know if my claim would get paid with the primary code not being medically necessary but my secodary code being medically necessary.

 

[mitchellde]

I understand, and the correct way to code this is still the V58.83 first and then the V58.69, then you can use 285.9 last. The reason for the test is the medication the patient is receiving. And yes you should have no problem with reimbursement as long as you link the number 1 and number 2 dx to the lab code. Do not link the anemia as this is not the reason for the test.