Wiki Annual Physical labs for Medicare patients

[MarilynS]

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Here is my problem. Medicare patient calls and makes an appt for a physical. They come in a week prior to get their labs done. The lab codes this with V70.0. The day of the Physical the Dr is reading the results and finds the patient has hypertension, or high cholesterol. The labs have already been sent to Medicare. Can we change the DX on some of the tests to reflect the findings? I say no. But the Dr is not buying that.
Thanks,
Marilyn CPC

 

[heatherwinters]

Medicare Screening Labs

If you look at Medicare's Quick Reference Information for Preventive services, they list specific codes that should be used for screening lab coverage.

For example for screening lipid panel, cholesterol, lipoprotein, triglyceride Medicare states they want you to report one or more of the following codes: V81.0, V81.1 and V81.2. This sheet can be found by going to Medicare's Learning Network. You should use these codes and not V70.0 codes on your orders based on history and what you are screening for.

http://www.cms.gov/Outreach-and-Edu...ducts/downloads/MPS_QuickReferenceChart_1.pdf

According to icd-9 coding guidelines: V codes are used when:

A person who is not currently sick encounters the health services for some specific reason, such as to act as an organ donor, to receive prophylactic care, such as inoculations or health screenings, or to receive counseling on health related issues.

If the no sickness, sign or symptoms was present at the time the lab order was made, then the physician should use a V code in his order for the lab work.

When the doctor interprets the test at an office visit and decides the patient has HTN or hyperlipidemia and manages those disease, that's when they get reported.

See also Medicare's Lab NCD for specific tests and covered screening icd-9 codes, you can download the ones you use most often.

http://www.cms.gov/medicare-coverage-database/indexes/lab-ncd-index.aspx?bc=BAAAAAAAAAAA&

If you refer to the 2012 Lab NCD Manual http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201201.pdf and refer to the non-covered icd-9 codes for all edits section, you will see that V70.0 is listed as a code that is never covered for Medicare screening labs.

On page 7 of the manual you can show your provider the following quote:

For screening tests, the appropriate ICD-9-CM screening code from categories V28 or V73-V82 (or comparable narrative) should be used. (From Coding Clinic for ICD-9-CM, Fourth Quarter 1996, pages 50 and 52).

I hope this information helps.