Pathology/Lab Coding Alert

Watch coverage rules for medical necessity -- or you could end up with denials Starting Oct. 1, ICD-9 gives labs new -health status- V codes to indicate the need for certain tests. But you-ll have to pay attention to laboratory National Coverage Determinations (NCDs) and other coding rules to make sure using these codes results in payment -- not denials.

For a list of the new history/genetic codes, see -Want to Show Family History/Genetic Carrier Status? Do This- in this issue.. V18.5x Aids Vigilance for Colon Cancer A family history of colon polyps might prompt a physician to order a fecal occult blood test (FOBT) (82270-82274) or screening colonoscopy with greater frequency or at younger ages than a patient without a family history. That's why new ICD-9 codes V18.51 (Family history of colonic polyps) and V18.59 (Family history of other digestive disorders) will be useful to physicians trying to explain why they-re ordering certain tests.

Having a family member diagnosed with colon polyps or cancer of the large intestine indicates an increased risk for colon cancer. -We haven't had a lot of great ways to describe this in the past, and these new V codes are going to be a great help,- says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle. Genetic Testing Gets a Boost New and revised V codes for procreative management and genetic screening are also part of the latest ICD-9 update.

Use the V26.3x codes when physicians order genetic testing for males or females as part of procreative management:

- V26.31 -- Testing of female for genetic disease carrier status

- V26.32 -- Other genetic testing of female

- V26.34 -- Testing of male for genetic disease carrier status

- V26.35 -- Encounter for testing of male partner of habitual aborter

- V26.39 -- Other genetic testing of male. Special case: You should not use these codes if a patient undergoes genetic screening not associated with procreative management. ICD-9 adds a new subcategory (V82.7x, Genetic screening) with two new codes as a parallel to the V26.3 codes when a person undergoes genetic tests unrelated to managing reproduction:

- V82.71 -- Screening for genetic disease carrier status

- V82.79 -- Other genetic screening. For example: A physician might order cystic fibrosis screening (83890-83914, Molecular diagnostics) for a patient with a family history of the disease. Selecting the proper V code as the reason for the test will depend on whether the test is for procreative management for a male or female -- or if the genetic screening is for another reason. Depending on these circumstances, you would code the reason for the test as V26.31, V26.34 or V82.71. NCDs Say -Not Covered- If a patient is at increased risk for disease because of [...]