tci Medicare Compliance & Reimbursement - 2011 Issue 8

Reader Questions: 'V' Code Can Help You Support Lab Test Claims

Question:Our laboratory received an order for a PSA test for a patient one year after successful prostate cancer treatment. What diagnosis and procedure codes should we use? Answer: Assuming the ordering physician does not list clinical evidence of recurrent prostate cancer as the reason for the test, you should report the diagnosis as V10.46 (Personal history of malignant neoplasm; genital organs; prostate) and report 84153 (Prostate specific antigen [PSA]; total) for the PSA test.Take care with cancer Dx: Don't list 185 (Malignant neoplasm of prostate) if the ordering physician does not indicate that this is a current...

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