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kccoding14

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We are an IDTF( independent diagnostic testing facility). Any thoughts on this is appreciated:
A patient is coming in for restaging breast cancer, s/p treatment in 2005.There is known mets. Since the patient ended treatment in 2005 will the mets be coded as primary or can you still code the breast cancer? We use the 3 year rule that if the patient hasnt had any treatment for 3 years then we dont code the cancer code, we use the V code( hx of), which medicare does not pay. Also, medicare does not pay for some the mets codes , in the 197- 198 range,secondary neoplasms, and some have to go through NOPR.
Has anyone used the breast cancer code even if its 6 years prior?
KC
 
I am not sure who your MAC is but mine is Highmark for the DC area and per that LCD, V10.3 is a covered diagnosis for restaging (PS) for FDG PET. I have had a problem with getting the Sodium Fluoride (NaF) PET's for bone mets covered with practically any codes.
 
Have you actually received a denial for 78815-PS (or 78814/78816) with dx V10.3? If so, what was the denial code/reason? Did you also include the code for the mets?
 
All of our V10 codes for personal history have been acceptable. Have you had a denial and was it definitely for the Dx?
 
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