? About billing echos for chemo-patients


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My question is when billing echos for chemo patient how do you correctly bill for it? Here in my office we were billing 424.4, v58.11, and primary cancer dx and we were getting paid for it now in the last month they wanted us to bill it with V81.2 only but the echo nurse also add V58.11 to bill so we billed it as V81.2 and V58.11 and they are be denied for wrong dx. Can anybody tell me the correct way to bill for this? P.S. Patient are getting this echo for pre-chemo start up. Thanks in advance for all the help and advice you can give me.:)
V58.11 is a first listed only dx code and must always be first, and is for the encounter for chemo, which this is not and therefore not valid. 424.4 is not a valid dx code but the 424 category is for diseases of the endocardium and should not be used unless the patient has a dx in this category. we just use the cancer dx code and this has always been sufficient.