Wiki fialed ness : additional Diagnossis needed 86704

[KC7NOA]

Im wondering what am i looking for to satisfy this failed ness : cpt 86704


"LCD edit: 36 - additional diagnosis code needed in order to pass medical necessity"

Have Z11.59, Z72.89 .... what else?

 

[thomas7331]

The coding will depend on the circumstances of why and for whom the test is being done. Here are the Medicare coding and coverage guidelines for Hepatitis B screening:

https://www.cms.gov/Medicare/Preven...s/MPS-QuickReferenceChart-1.html#HEP_B_SCREEN

 

[KC7NOA]

additional info

The Pt is a 68 yr old Male

E11.9 and Z72.89 (high risk sexual activity) are all that's listed on the Lab order

The Visit is diabetic visit and he wanted a Hep C testing ...

From the Ofc visit i can clear the Hep B surface anti (87340) , but not the Hep B core hbcab (86704) ...

 

[thomas7331]

You can only code from what you have documented. G0499 is the only HBV screening service that is covered by Medicare for this class of individuals - if the coverage criteria were not met, then an ABN probably should have been obtained prior to performing the test.