Wiki Help with DX codes on lab order

[cmanion]

I am a biller at a Family practice, we had a patient call to request to have blood work done because she is losing weight and has hair loss and is concerned. The Doctor Ordered a COMP METABOLIC PANEL W/FASTING GLUCOSE and a CBC/PLT/DIFF/INDICES with DX code R63.4(abnormal weight loss), He also ordered a TSH WITH REFLEX TO FT4 with the DX code L64.8 (Other androgenic alopecia).
The patient's insurance rejected these tests due to the DX codes not being medically neccesary, I'm being told that I can send in a new lab order with different DX codes on it so the lab can resend the claim. I've never dealt with this situation and I'm wondering is this something I can do? and if so, what other DX codes can I use?

 

[thomas7331]

You can send a corrected lab order, but only if the diagnosis codes originally submitted were incorrect and/or incomplete. Start by reviewing your documentation to see if the order was coded correctly. You may also query your provider for confirmation, clarification or specificity in their documentation that may help you to reach a more accurate code, but be sure not to 'lead' the provider toward any specific code. But if in fact the codes originally submitted are correct, then there really isn't any more you can do. If the patient's plan does not cover those tests for the problems that they have, then that's an issue that the patient will have to take up with their own insurance company.

 

[cmanion]

You can send a corrected lab order, but only if the diagnosis codes originally submitted were incorrect and/or incomplete. Start by reviewing your documentation to see if the order was coded correctly. You may also query your provider for confirmation, clarification or specificity in their documentation that may help you to reach a more accurate code, but be sure not to 'lead' the provider toward any specific code. But if in fact the codes originally submitted are correct, then there really isn't any more you can do. If the patient's plan does not cover those tests for the problems that they have, then that's an issue that the patient will have to take up with their own insurance company.

Thank you for the information, I greatly appreciate it!