Re: Medicare & BMT evaluation testing

[Guest guest]

:

We have only had the issue with the HIV/NAT testing. We added the V42.82 diagnosis code as well along with the cancer dx and it did not pay on the Medicare patients. I would take the letter from Quest requesting any additional diagnosis codes to a nurse and have her review the chart for anything else that might work but there usually wasn't ever anything....I have yet to have a patient bring me a bill from any of the other testing you mentioned kick out for non-covered based on the diagnosis.

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Subject: Medicare & BMT evaluation testingTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, July 19, 2012, 4:24 PM

Our facility recently started using an edit system that tells our staff if a Medicare ABN is needed for a particular procedure when the diagnosis code is entered, and we’re finding that many tests are hitting the edits. For example, no cancer diagnosis seems to be allowed for HIV antibody or antigen screening, yet standards require that transplant patients be tested for that virus. There’s no diagnosis code for “Transplant Candidate†so we have to use the disease ICD-9. We’re being asked by our business office to have patients sign Medicare ABN forms, which seems unfair when these are medically necessary tests. We also don’t know if the test will actually be denied, or if the edit is just a “warning.â€

Has anyone else had any issues regarding Medicare coverage (or a need for an ABN) for PFT, stress echo, viral serologies, etc. when using a cancer diagnosis? Thanks in advance.

Goldstein

Business Manager, Stanford BMT Program

300 Pasteur Drive, H0101

Stanford, CA 94305

~ - direct

~650.725-3117 - fax

~ - BMT office

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