Cardiology Coding Alert


Post-Chemo ECG May Need Special Dx Code

Question: We perform ECGs on some patients to monitor whether chemotherapy drugs, such as Trisenox, affect their hearts. What diagnosis codes should we use for these services?

Mississippi Subscriber

Answer: If the ECG results are normal, you should report a "special screening" V code for the diagnosis.Depending on your documentation, report one of the following codes:

• V81.0 -- Special screening for cardiovascular, respiratory, and genitourinary disease; ischemic heart disease

• V81.1 -- ... hypertension

• V81.2 -- ... other and unspecified cardiovascular conditions.

Potential problem: Payers may not cover the cost of a screening exam. If your payer won't reimburse you for a screening, you may need to obtain an advance beneficiary notice (ABN) from the patient. Ask him to sign the form that says he agrees to pay for the test if Medicare won't cover it. Some private payers offer similar waivers.

Try this: Some payers will reimburse you for heart studies if you include one of the following codes. Remember to report codes only if your documentation supports them:

• V58.42 -- Aftercare following surgery for neoplasm

• V58.69 -- Long-term (current) use of other medications

• V58.83 -- Encounter for therapeutic drug  monitoring

• V66.2 -- Convalescence and palliative care;following chemotherapy

• V67.2 -- Follow-up examination; following chemotherapy.

Note: If the patient does have a documented heart condition, you may report the diagnosis code for that condition. Report documented ECG findings using secondary diagnosis codes.

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