Oncology & Hematology Coding Alert

Question: We perform EKGs on some of our patients to monitor the effect of chemo drugs, like Trisenox, on their hearts. What diagnosis codes should we use for these services?


Idaho Subscriber
Answer: If the EKG 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 ischemic heart disease

-  V81.1-Special screening for hypertension

-  V81.2-Special screening for other and unspecified cardiovascular conditions.

Snag: Most payers won't cover the cost of a screening exam. If your carrier 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. Some private payers offer similar waivers.

Try this: Some payers will reimburse you for heart studies if you include one of the following:

- V58.1-Encounter or admission for chemotherapy

- V58.42-Aftercare following surgery for neoplasm

- V58.69-Long-term (current) use of other (high-risk) 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 EKG findings with secondary diagnosis codes.