How to Get Paid for Drug Monitoring Tests
Published on Tue Sep 23, 2003
We'll tell you how to use 3 new V codes Physicians sometimes order lab tests to monitor patient response to medication - but your lab can't get paid without showing medical necessity. ICD-9-CM 2004 adds three new, specific drug-use V codes you'll have to use, according to CMS' National Coverage Determinations (NCD) and other guidelines. New ICD-9 Codes Are More Specific Effective Oct. 1, ICD-9 added three new five-digit codes under V58.6x (Long-term [current] drug use). The new codes are: V58.63 - Long-term (current) use of antiplatelet/antithrombotic V58.64 - Long-term (current) use of non-steroidal anti-inflammatories (NSAID) V58.65 - Long-term (current) use of steroids. The subcategory already included the following subclassification codes: V58.61 - Long-term (current) use of anticoagulants V58.62 - Long-term (current) use of antibiotics V58.69 - Long-term (current) use of other medications. "The biggest change you'll see is that many tests which you previously reported using the 'other medications' code V58.69, you'll now have to report with one of the new codes," says Anne Pontius, MBA, CMPE, MT (ASCP), president of Laboratory Compliance Consultants Inc., in Raleigh, N.C. "You should only report a 'not otherwise specified' ICD-9 code if a more specific code is not available." Experts offer the following advice on using the three new codes accurately: 1. Use V58.64 for Aspirin and Other NSAIDs Although physicians previously ordered lab tests to monitor the effects of long-term NSAID use with V58.69, they should now report the more specific code, V58.64. Physicians often prescribe NSAIDs for long-term inflammatory disease treatment, and the drugs can cause blood thinning and stomach irritation.
That's why CMS added V58.64 as a payable diagnosis to the fecal-occult blood test NCD. "If a physician orders a guaiac-based fecal blood test [82270, Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations] to evaluate possible stomach bleeding in a patient taking aspirin or Daypro, for example, the physician should use V58.64 as the ordering diagnosis," Pontius says. CMS also added V58.64 as a payable diagnosis to NCDs for the following tests:
Blood glucose 82947 - Glucose; quantitative, blood (except reagent strip) 82948 - ... blood, reagent strip 82962 - Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use Lipid 80061 - Lipid panel 82465 - Cholesterol, serum or whole blood, total 83715 - Lipoprotein, blood; electrophoretic separation and quantitation 83716 - ... high-resolution fractionation and quantitation of lipoprotein cholesterols (e.g., electrophoresis, nuclear magnetic resonance, ultracentrifugation) 83718 - Lipoprotein, direct measurement; high- density cholesterol (HDL [...]
