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jennlp123

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I work in an Oncology office. We work as an infusion center for a few doctors we have been giving things like actemra and reclast. Our doctor orders a cbc on these patients prior to giving their infusion. I was thinking that you would be able to use the V72.63 which is blood test prior to tx or procedure but medicare is denying it because it is not a covered diagnosis. I have spoken with the doctor and he says that he needs this test to monitor toxicity. I researched prior claims before and it looks as if they were being given the 285.9 anemia code. I am not comfortable doing this because it doesn't state that the patient has anemia in the progress note. Any suggestions on how to code this correctly?:eek:
 
jennlp123 said:
I work in an Oncology office. We work as an infusion center for a few doctors we have been giving things like actemra and reclast. Our doctor orders a cbc on these patients prior to giving their infusion. I was thinking that you would be able to use the V72.63 which is blood test prior to tx or procedure but medicare is denying it because it is not a covered diagnosis. I have spoken with the doctor and he says that he needs this test to monitor toxicity. I researched prior claims before and it looks as if they were being given the 285.9 anemia code. I am not comfortable doing this because it doesn't state that the patient has anemia in the progress note. Any suggestions on how to code this correctly?:eek:
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You have coded it correctly. You cannot code a diagnosis not documented for this patient for this encounter. If the dx is not covered and you have not obtained an ABN then you will need to adjust this off
 
Deb's correct. The documentation has to be in place on the order, or within the medical record (from which the diagnosis can be abstracted).

We've found that in our oncology service, there are lots of lab LCDs that we have to pay attention to. With every lab order we write, we run a medical necessity check to make sure the code sets meet the limitations of the LCD. If not, we get an ABN signed. Also, we educate our providers as to what the LCDs say....so that they understand what is covered, and the rationale for the limitations. What we've found is that medical necessity is almost always met from the medical record perspective, but the providers don't issue the correct ICD-9 code on the lab order.
 
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