I have some insight on this from my coding rejections and working denials in the laboratory field. Patient contacts their provider for their upcoming "physical" and wants their "annual" labs done. Provider puts orders in with Z00.00 and patient has labs drawn a few days before their actual physical. No interpretation provided by provider on any of the results because it will be discussed during the office visit for the "physical".
Let me provide an example. The provider ordered laboratory testing for 85025, 84443, 82306, 83036, with 80061 with dx Z00.00. Again, depending on their insurance - the client is possibly not seeing any costs related to these labs (because on the backside of billing, none of these labs actually "meet medical necessity" with Z00.00 as the diagnosis code and are probably assigned a GZ modifier for that very reason). If the GZ isn't applied and the claim makes it out the door (probably for a commercial insurance); the odds are it will be denied for "not meeting" medical necessity and without solid proof to state otherwise those claims are written off. I know that most would like to believe that only "Medicare" is abiding by this LCD rule, but seriously from my review it is just about all insurances (Medicare, Medicare replacement plans, and most commercial plans).
Personally, dealing with patient inquiries - I clearly know that patients get crabby that they have a medical condition and somehow think that if they have "annual" labs done that it should be covered and sometimes in their mind it is because of how lab orders were entered with a GZ modifier or without the possibility of an invoice correction or appeal.
Thanks for listening and have a great evening,
Dana
