tumor markers

Does anyone have a dx code that covers these. Primary cancer codes don't seem to work. Paula P

Tumor markers

Each tumor marker is for a specfic type of cancer. What tumor maker are you trying to cover and with what dx's?

tumor markers

The ones I am having the most trouble with are: CA-125, CA-15-3, & CA 27-29.
We have routinely just used the primary cancer codes, but that is not what the
labs are looking for. Is there a screening V code that could be used? Paula P

Tumor markers

Ca-125 is for GYN cancers mostly. CA-15/CA-27.29 -Breast cancer etc
The Medicare National Coverage Determinations covers the following dx's -(I have copied the LCD's for the ones you have listed) for a CA-125 (86304)-
158.8
Malignant neoplasm, specified parts of peritoneum
158.9
Malignant neoplasm, peritoneum, unspecified
180.0
Malignant neoplasm, endocervix
182.0
Malignant neoplasm of corpus uteri, except isthmus
183.0
Malignant neoplasm,ovary
183.2
Malignant neoplasm, fallopian tube
183.8
Malignant neoplasm, other specified sites of uterine adnexa
184.8
Malignant neoplasm, other specified sites of female genital organs
198.6
Secondary malignant neoplasm, ovary
198.82
Secondary malignancy of genital organs
236.0-236.3
Neoplasm of uncertain behavior of female genital organs
338.3
Neoplasm related pain (acute) (chronic)
789.39
Abdominal or pelvic swelling, mass or lump of other specified site
795.82
Elevated cancer antigen 125 [CA 125]
795.89
Other abnormal tumor markers
V10.41
Personal history of malignant neoplasm, cervix uteri
V10.42
Personal history of malignant neoplasm, other parts of the uterus
V10.43-V10.44
Personal history of malignant neoplasm of female genital organs

CA-15/ CA-27.29 (86300)
174.0-174.9
Breast, primary (female) - malignant neoplasm of female breast
175.0-175.9
Breast, primary (male) - malignant neoplasm of male breast
198.2
Secondary malignant neoplasm (skin of breast)
198.81
Secondary malignant neoplasm (breast)
338.3
Neoplasm related pain (acute) (chronic)
795.89
Other abnormal tumor markers
V10.3
Personal history of malignant neoplasm, breast

tumor markers

Wow!!! This is what I needed. Thanks for the info. Paula

Tumor markers

Anytime Glad to help.
Andrea Coots

markers

You are not going to get paid unless they have cancer or a history of cancer. The CA 125 is a high molecular weight serum tumor marker elevated in 80 percent of patients who present with epithelial ovarian carcinoma. It is also elevated in carcinomas of the fallopian tube, endometrium, and endocervix. An elevated level may also be associated with the presence of a malignant mesothelioma or primary peritoneal carcinoma. The CA 125 levels are again obtained at the completion of chemotherapy as an index of residual disease. Surveillance CA 125 measurements are generally obtained every 3 months for 2 years, every 6 months for the next 3 years, and yearly thereafter. CA 125 levels are also an important indicator of a patient’s response to therapy in the presence of advanced or recurrent disease. In this setting, CA 125 levels may be obtained prior to each treatment cycle.
These services are not covered for the evaluation of patients with signs or symptoms suggestive of malignancy. The service may be ordered at times necessary to assess either the presence of recurrent disease or the patient’s response to treatment with subsequent treatment cycles.
https://www.cms.gov/manuals/downloads/ncd103c1_Part3.pdf

tumor markers

Have you tried these? confirmed diagnosis of breast cancer (174.x-175.x, 198.2, 198.81 or V10.3)