Wiki Coding for routine labs?

[snwhite0730]

Hello Coders,

I am hoping someone can give me a little guidance on billing/coding labs ordered during AWV/CPE visits. I have two scenarios that are giving me issues and we are getting denials for routine labs ordered during well visits. What I really need to know is can I link the diagnosis given in the assessments with the labs the MD ordered if the documentation only list Annual Wellness Exam, if I have conditions/diagnosis that will cover medical neccessity?

1. With the AWV/CPE labs the providers just list ALL of the labs under the Z00.00 code in the treatment portion of their documentation. As we all know Z00.00 doesn't cover labs so we are getting denials for all of the labs the providers are ordering. If the providers list other diagnosis/conditions in their documentation that support medical necessity , as a coder can I link the diagnosis to the appropriate lab?

2. How are you all handling visits for just lab draws if the MA's are not listing codes or only placing the Z00 codes?

I can't find anything that says for sure that the coder can or cannot link diagnosis to labs and it's driving me a bit crazy. The MD's list diagnosis in the chart, the test they ordered would be supported by that diagnosis (i.e. AWV MD orders CBC. Pt has a diagnosis of I10 which covers medical necessity) but he doesn't directly link it in the documentation. How does this work? Can I add codes to the lab procedures that will cover medical neccesity? or is this the same as with coding the charts and I cannot assume he needs the test for that reason and we have to keep the labs under the Z00 code because that is how the provider listed it in the chart?

 

[danachock]

Hi snwhite0730
May I assume you work your own denials?
I will try to help okay.
Scenario 1 - there isn't much to do, it's a cluster ~ either education or appeal. I have already dealt with so many patient inquiries on this very scenario you need to find a solution. Did you review the results from the provider? Or the letter they sent on their laboratory results? Or possibly the OV following the patient's lab draw the next day at their patient's AWV?
If provider states Z00.00 - it is what it is. If provider reviews results and renders a diagnosis in the electronic health record, it is appropriate or if the letter they had sent following labs stated that they (patient) had a medical condition, then I would be alright coding it. Or if their AWV was clearly within a few days of the laboratory draw and from those laboratory results the provider found or stated something - I would., "any findings is a case by scenario".
PLEASE do not code those phrases like "consistent with" or otherwise. Personally, in my opinion, our providers are so jammed up with clinical work (paperwork, coding and the first time they get a patient inquiry that is "like seriously all caps" that my laboratory charges weren't covered they won't do that mistake SERIOUSLY EVER again). I'd appeal every one of these laboratory examples with medical notes if they just simply are trying to please the patient with documentation to support billing any charges. I am not putting any one under the tires, but everyone loves Z00.00
Next let's tackle #2
Scenario 2
2. How are you all handling visits for just lab draws if the MA's are not listing codes or only placing the Z00 codes?
My opinion if MA's are not listing diagnosis codes you clearly have an invalid lab order and the draw/whatever should not be performed on CPT codes without dx code.
Possibly an accessioning issue?? Please do not be discouraged.
Our providers really want to be the "best of the best" - could you just query please? I know that this may not be possible if you have an outside order. Please contact your medical director directly on this issue.
How does the pathology department code a dx (diagnosis) when we don't have complete information?
I will share with you I have had the opportunity of some accessions that they provided the specimen(s) and all was normal (no abnormality) and no valid diagnosis. You need to email your medical director at your facility. If they gave you something note for clarification based on your coding scenario.
Again, Z00.00 is every provider's favorite default code Yes, call me a liar. They are overworked clearly swamped; nah more like flooded with information and diagnosis and
CPT assignment.
I apologize and failed to mention that an abnormality with laboratory results is provider driven. You MAY NOT REVIEW the results and provide a diagnosis code based on the RESULTS. Let me provide simple phrases I see with NO PHI okay ~
I see documentation on the provider telling either in the lab results "via my chart" or otherwise that patient is pre-diabetic ~ the patient needs to focus on diet/exercise,
I also see documentation from labs on the blood draw the previous day and the patient had a AWV check up the following day and the provider stated "Your labs look great on the testing for your thyroid issue", We will proceed with your with previously prescribed prescription and follow up next year. You can come up with your own conclusions. Please remember we are pathology/laboratory specialists. If something is a miss it may be alright contact your medical director directly! on this They run your facilities So be cognizant. Gosh, they were super helpful on many cases. No one in the pathology world or laboratory world wants to not have RVU's. I hope I caught everything without a revision okay!

Thank you for listening,
Dana Chock