Wiki V71.1 Suspected Neoplasm

[JM.Geyer]

There is an issue here in my office in regards to using the V71.1 code. My nurse manager says since we are a Cancer Center we are obligated to use this code because if we get audited and we don't we can be "dinged". I say this is a last resort code only and that we need to code the symptoms the patient is having that is causing the suspicion of neoplasm. When is it correct to use the V71.1 code?

 

[preserene]

V71.1 is the primary listed code; Observation and Evaluation for suspected conditions not found, get the priority as the first listed code- please see the coding guidelines page 21 and 17 of ICD-9 CM.The observation codes are to be used as principal daignosis only. the only exception is a code from V30

 

[mitchellde]

There is an issue here in my office in regards to using the V71.1 code. My nurse manager says since we are a Cancer Center we are obligated to use this code because if we get audited and we don't we can be "dinged". I say this is a last resort code only and that we need to code the symptoms the patient is having that is causing the suspicion of neoplasm. When is it correct to use the V71.1 code?

I worked in a cancer research facility and we used this code quite often. It is first listed only. It is especially helpful for skin lesions where the physician will excise the lesion and when the path returns it is benign. There have been times where these were rejected by the payer as a cosmetic procedure, so we started using the V71.1 as the first listed with the benign result secondary, this stopped the denials and the claims were paid without having to appeal.