Question: Whats the best way to avoid delays in reimbursement for lab tests done before chemotherapy?

Anonymous Virginia Subscriber

Answer: If you put the cancer diagnosis code first (for example, testicular cancer, 186.9) then the V58.1 chemotherapy code, and finally the codes for the various lab tests, you usually can get everything paid for except pulse oximetry (94760).

Pulse oximetry is used most often for patients who have dyspnea, which is shortness of breath or distress in breathing. These would probably be patients with primary lung cancer or those with metastases in the lung.

The code series for dyspnea is 786.00-786.07; note that this diagnosis requires a fifth digit. So you put the diagnosis code for dyspnea first (786.00), then the pulse oximetry code (94760), followed by the lung cancer diagnosis code (162.0-162.9) and whatever secondary diagnoses are related such as cough (786.2) and hemoptysis (786.3). The insurer also wants a measurement of oxygen levels in the air of the infusion room. That has to be entered on line 19 of the HCFA form.

(This answer is from Jere Rosewech, Carolina Cancer Center.)