Pediatric Coding Alert

Question: If a physician knows that a patient has a condition, can you bill a lab screening code? For example, a patient who has hyperlipidemia comes in for a preventive medicine service, and the physician orders a lipid profile.-Should I use a screening or hyperlipidemia diagnosis? Illinois Subscriber Answer: Because the physician has already established the diagnosis of hyperlipidemia, you should use the available definitive diagnosis: hyperlipidemia (272.4, Other and unspecified hyperlipidemia) if the physician addresses or treats that condition at the preventive medicine service. The physician is supposed to code the diagnosis he knows at the end of the encounter, according to ICD-9 guidelines. You would use a screening diagnosis when you are truly screening -- testing in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. If the physician discovered the diagnosis during the screening then you would [...]