Wiki V71.1 and PET scans?

[kimmyrummer@hotmail.com]

We have a coding audit consultant telling us not to use V71.1 when the patient has a mass or LN or other ill-defined situation when we code for PET scans; even though the scan is negative.
For example: Patient has a lung mass, our group codes it V71.1, 793.11 because there was concern that it was a malignant process.

When we bill it without the V71.1 we get denied.

Is anyone else having this issue?
Thank you.
Kimberly, CPC, CPC-H, CHONC

 

[mitchellde]

You are using the V71.1 correctly. What was the consultants rationale for saying it was incorrect.

 

[kimmyrummer@hotmail.com]

V71.1 and PET Scans?

She said the V71.1 should not be used as the mass is a sign/symptom and the code says the obsv codes are not used if any injury or illness or any signs or symptoms related to the suspected condition are present.
Thank you!

 

[mitchellde]

That is not what the V71 code catergory states and there is nothing in the guidelines that states that, you would not use that category if you knew the patient had the condition, or before you had the study results. A mass is an abnormal condition which requires study to determine the exact nature of the mass, so I disagree with her.

 

[kimmyrummer@hotmail.com]

Great Debra, Thanks. We disagree with her as well, but wanted to make sure we weren't misunderstanding it and find out if others are having the same issue and what to do about it.
Thanks again! Kimberly, CPC, CPC-H, CHONC

 

[mitchellde]

If the provider diagnosis this as a lung tumor you could use a 239 for neoplasm unspecified as your secondary.