Andrea- The Clinical Cytometry Society is happy to serve members by assisting in such issues. We, along with the CAP, have been successful in recent challenges in other states by educating third party payers as to the practical issues. The two IDC-9 codes that generally are accepted and appropriate for the circumstances you describe are: Suspicious disease process; ICD-9 795.4 , Lymphadenopathy; ICD-9 785.9. In my experience, both personally and acting for CCS, a meeting with the Medical Director of the insurance carrier is usually successful in resolving these misunderstandings. However, if you would like CCS to assist you in this protest, please do not hesitate to contact me directly. Regards, Bruce H. Davis, M.D. Trillium Diagnostics, LLC c/o Maine Medical Center Research Institute 81 Research Drive Scarborough, Maine 04074 USA PHONE: 207-885-8113 FAX: 207-885-8110 Email: davisb@mmc.org >>> "Andrea Illingworth" <dcdsflow@mint.net> 01/16/02 03:27PM >>> Dear group, The hospitals we serve as a Flow Cytometry reference laboratory seem to have some issues regarding Medicare reimbursement due to the ICD9 code being used. The scenario is a follows: The flow lab receives a lymph node with the suspected diagnosis of r/o lymphoma. The lab does the analysis but finds no evidence of a lymphoproliferative disorder. If the hospital (or whoever is asking to be reimbursed) uses the "correct" ICD9 code of lymphadenopathy, they don't get reimbursed (since the code is not part of the LMRP. If they use the Suspected diagnosis code (lymphoma), this could be construed as a false claim. One of our pathologists is in the process of writing to the Fiscal Intermediary to include lymphadenopathy and enlarged lymph nodes as an acceptable diagnosis added to the LMRP. Another problem area is also when we get a bone marrow "for flow" (the kind of see-what-you-can-find type of thing). Which code do we use when we don't find anything malignant and still would like to get reimbursed? Any thoughts or insights from the billing experts on this issue are much appreciated. Thank you - Andrea Illingworth, MS Dahl-Chase Dx Services - Flow Cytometry 333 State Street Bangor, Maine 04401
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