Medicare Still Unsure On Coding For Prostrate

Medicare Still Unsure On Coding For Prostate Screening

The Medicare medical billing dilemma about prostate screening coverage is still a heated issue. Almost all preventative care in the past was not covered by Medicare. Recently, they decided to allow billing for medical prostate cancer screening charges. The problem is that the Centers for Medicare & Medicaid Services never removed V76.44 (Special screening for malignant neoplasms of the prostate) from the non-covered codes list. This medical billing problems has brought much confusion to the medical world.

Many medical billing personnel have become confused by this conflicting new rule. As the Centers for Medicare & Medicaid Services have it now, the current procedural terminology code for prostate cancer screening is accepted when performing medical billing. However, the ICD-9 code for prostate cancer screening, V76.44 is still a deniable code. This billing confusion has brought much concern in the medical world. How can the CPT code be allowable, but the ICD-9 code be deniable for the same procedure?

The Centers for Medicare & Medicaid Services realize this contradiction cannot exist any longer. They opened a section on their website on Aug 9 for one month. This section asked for public comments on whether or not V76.44 should be taken off the list of non-covered codes.

This medical billing public forum closed on September 9, 2005. Although the results did have mixed answers, the majority agreed that Prostate Cancer screening CPT and ICD-9 codes should be allowed since both medical billing codes provide necessary medical care to patients. They did agree that by not covering these screening charges, the Centers for Medicare and Medicaid Services might actually end up paying more for prostate cancer treatment. The allowance of medical billing ICD-9 code V76.44 should be allowed for the health of all patients, but the Centers for Medicare & Medicaid Services has not made it’s final decision yet.

View all Articles by: Melissa Clark, CCS-P