Oncology & Hematology Coding Alert

Question: The oncologist saw a patient for a follow-up exam regarding bladder tumors. The physician listed V10.51 (Personal history of malignant neoplasm; urinary organs; bladder), and I linked the ICD-9 code to 99213. Our carrier denied the claim. What did we do wrong? Should the doctor use a different V code?

Florida Subscriber Answer: The carrier may have denied your claim for two reasons. First, to report 99213 (Office or other outpatient visit ... established patient), your oncologist must meet two of three components: expanded-problem focused history and examination, and low-complexity medical decision-making. Make sure the medical documentation supports this.
 
Choosing to link a secondary ICD-9 code (V10.51) may have led to the denial. You may want to use the primary diagnosis code instead. For example, if the patient has bladder cancer, list (188.x, Malignant neoplasm of bladder). Follow these criteria for using V codes:
 
  Link a V code to procedures for patients who require services such as a prophylactic vaccine.
  Use V codes when reporting chemotherapy treatments.
  Report a V code as an additional factor during treatment, such as a personal history code. You should also check the follow-up visits' frequency and timing. Carriers consider follow-up visits within 90 days of radiation therapy included in the radiation therapy services.