Labs required per drug prescribing info


Lincoln, NE
Best answers
Good afternoon. I have a question regarding diagnosis for certain tests that are required for patient's receiving certain drugs. For example, Opdivo requires thyroid testing. In review of the covered codes for TSH testing, there is no code that would cover testing in this case. Another example would be administering B-12 injections for Alimta. Previously there was an ICD-9 code (V07.39) that stated need for prophylactic chemotherapy. This now transfers to either Z41.8 which is an encounter code or Z79.899 for long term/current drug therapy. In my Opdivo example, the patient has not yet received any chemotherapy, so the Z79.899 would not be valid and Z41.8 is not covered.

Also, I have had problems with commercial carriers when using the Z41.8! Any insight would be fabulous!

Thanks in advance

Rachel Brunswick, CPC, CHONC