Wiki ECHO question

[lmlaprise]

I bill for a mobile diagnostic company who has been hired by an oncology group to perform baseline ECHOS prior to patient receiving chemo therapy.

However, the only dx codes indicated for coverage are post chemo and during chemo. None seem to indicate baseline prior to chemo.

ANy codes that this provider can use to get his baseline echos paid by medicare?

 

[deeva456]

The only billable and payable codes you can bill with are on the LCD list,
L28254. If doing a baseline echo, prior to receiving chemo, is the only reason to perform an echo, you will have to dig deeper for a billable dx. Does the patient have any other cardiac related conditions, have they experienced other symptoms that would support the medical necessity to perform the echo? Can you use V45.11 or V45.12? Description heading for V58.x
is "encounter or admission for chemotherapy".

Dolores, CPC, CCC

 

[lmlaprise]

He is already submitting with v58.11 and that is being denied by medicare. I kinda told him the same thing..he may have to dig into patient hx to see if there is anything else he can use to substantiate the echo.

 

[deeva456]

If your MD is billing the echo with dx V45.11 and Medicare is denying payment then I would call Medicare. This is not uncommon, it has happened in our practice as well. Or, some other error may cause your claims to be denied.

Good luck!
Dolores

 

[jerseygirl66]

You should check with your Medicare carrier and their LCD for the appropriate code for this (LCD numbers vary by state). Although most Medicare policies state it is a baseline is a covered service, many differ on what ICD-9 should be used. New York allows v81.2 Screening for other and unspecified cardiovascular conditions.

To quote Empire Medicare:

4. Exposure to Cardiotoxic Agents (chemotherapeutic and external)
Measures of myocardial contractility, thinning and dilatation are important in the titration of therapeutic agents with known myocardial toxicity. When echocardiography is used to monitor cardiac toxicity of chemotherapeutic agents (e.g., degenerative cardiomyopathy produced by doxorubicin therapy), an initial complete TTE may be performed prior to first administration of the agent with the frequency of repeat studies determined by the patient's clinical course and the toxicity profile of the agent being administered, although tests performed bimonthly during chemotherapy and at six (6) months following therapy are generally considered medically appropriate.

Hope it helps