History of cancer w/Medicare

[tdove]

Medicare does not cover V10.51 history of bladder cancer or V10.46 history of prostate cancer but the physicians feel it is necessary to have patients come in annually. Is anyone else billing medicare and how are you billing with the V Codes or with the 188.9 and 185? Do you have the patients sign ABN or just let them know the visit may not be covered?

 

[mitchellde]

If the cancer is no longer present and the patient is no longer receiving active treatment then you cannot use active cancer codes it is by definition history of cancer. If the patient is being seen by the provider after the cancer is "cured". Then the appropriate first listed code is the V code for follow up following chemotherapy or radiation, if the patient received both therapies then you use the follow up for the one that was the last one applied. The secondary code is the history of cancer code. I have never had an issue with this being covered by Medicare for an office visit. Who told you that Medicare does not cover cancer follow up? Or are you trying to bill something other than an office level.

 

[ljulien]

Use V67.x (depending on the type of tx pt received) as primary and the cancer history codes as secondary. You should not have any problems with Medicare billing for surveillance visits using the instructions above.

 

[tdove]

medicare denying ov w/V codes

I have received denials on our office visits when I use V10.51 or V10.46. These patients usually have had a procedure or are coming in for a pre op before there survillance cystoscopy which we bill between a 99213-99214.