Question:
We are adjusting off quite a few computed tomography (CT) scans that are performed to follow up a cancer diagnosis after treatment is complete. Our state’s local coverage determination (LCD) covers the cancer diagnosis code but does not cover the “history of” the specific cancer nor does it cover Z08 for completion of treatment. Is there any compliant way around this denial? For instance, can we bill the cancer diagnosis that is covered even though the report states no evidence of recurrence or metastasis?
Answer:
Medicare doesn’t cover “watchful waiting”– just checking to see if there has been recurrence without some kind of medical necessity. Other payers may or may not allow that. For Medicare, you must have medical necessity – a problem, not just routine yearly checking. You should not report a current cancer diagnosis code when the patient is no longer being treated for the cancer.
This question was answered in an edition of our Radiology Compliance Manager. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24