Bariatric Screening Lab?

angiewelbern@cox.net

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BCBS is denying our labs that we have ordered on our Bariatric patients due to not medically necessary. We order these to see if there are any comorbidities that the patient/physician isn't aware of. This really wouldn't be considered pre-operative lab work, as we haven't scheduled the surgery yet.

We used E66.01 Morbid Obesity, I10 Hypertension, E78.5 Hyperlipidema, K21.9 GERD & Z68.41 BMI of 46.9.
The labs ordered: Vitamin B6, B12, Copper, Calcium, D, Iron, Magnesium, Zinc, Prealbumin, PTT & Folic Acid.

I can't find anything in the provider manual as to why these aren't acceptable diagnosis codes. Could it be due to the BMI was coded last? Do I need to use a screening code as the primary dx? Like Z13.89? Or should I throw the kitchen sink at them with Z13.0. Z13.21, Z13.220, Z13.818 & Z13.89?

Thanks!
Angie Welbern
 

mitchellde

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Are you screening to see if the patient has these conditions, or has the patient already been diagnosed with these conditions?
When you code as you stated:
We used E66.01 Morbid Obesity, I10 Hypertension, E78.5 Hyperlipidema, K21.9 GERD & Z68.41 BMI of 46.9.
This means these conditions have been previously diagnosed in this patient and is currently under treatment.
If that is not true then you cannot use those codes for this patient.
If as you state:
The labs ordered: Vitamin B6, B12, Copper, Calcium, D, Iron, Magnesium, Zinc, Prealbumin, PTT & Folic Acid.
Are for screening purposes, then that means that these conditions have not been diagnosed and are not being treated. If this is the case then you use only the screening Z codes. Use the Z01.812 first listed for preprocedural lab.
 

angiewelbern@cox.net

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Yes, the patient was previously diagnosed with I10, E78.5 & K21.9 - these are comorbidities of his obesity. I'll try the Z code - Thanks!

Are you screening to see if the patient has these conditions, or has the patient already been diagnosed with these conditions?
When you code as you stated:
We used E66.01 Morbid Obesity, I10 Hypertension, E78.5 Hyperlipidema, K21.9 GERD & Z68.41 BMI of 46.9.
This means these conditions have been previously diagnosed in this patient and is currently under treatment.
If that is not true then you cannot use those codes for this patient.
If as you state:
The labs ordered: Vitamin B6, B12, Copper, Calcium, D, Iron, Magnesium, Zinc, Prealbumin, PTT & Folic Acid.
Are for screening purposes, then that means that these conditions have not been diagnosed and are not being treated. If this is the case then you use only the screening Z codes. Use the Z01.812 first listed for preprocedural lab.
 
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