I do the same thing, Debra. I just remove the code when my physicians add it to their new patient visits.
Question for you....what if a patient is healthy, no concerns, and just comes in to establish care. Physician orders screening labs and has the patient return for a annual physical and lab review. There have been times when the provider will use ONLY that Dx code and when I ask for something else they say that they have nothing else to code based on the patient's current health status. I know insurance companies typically don't pay for this type of "meet and greet" visit. Would love some feeback/advice on how to handle such a situation.
This exact scenario is something I've been battling since I've been here. It's an issue at the front desk, clinical, provider, coding, and billing levels and is a nightmare if everyone is not on the same page. In a nutshell, like you said, "establish care" is not a payable reason for visit - it doesn't meet medical necessity - so unless the provider is doing an actual annual physical exam (meeting the requirements for that E/M) at that initial new patient appointment (with or without abnormal findings), a lot of payers won't cover a "meet and greet". We've had to do extensive training for front desk, clinical staff, as well as providers on this so patients are aware up front (starting with that first call to schedule an appt) that if they don't have any concerns or health issues at all, it should be scheduled and performed as an annual preventive physical. For us, it came down to involving our director of physician services to announce at their all provider meetings that "establish care" will no longer be used as a reason for visit and a new patient appt is either an annual physical or problem-based. This way, our front desk staff, clinical staff, and even coders had management backing so there was less pushback from the providers themselves. So this works for most commercial payers... Medicare, on the other hand, won't even cover a preventative annual physical and only covers a MAWV (which, turns out, most of our clinical staff and providers still refuse to do at an initial NP appt because it's more involved and has more requirements.) So MCR patients are still a little up in the air but typically have SOME concern or dx at the time of scheduling (even if it's just for a prescription med refill for HTN) that can be used for RFV and then a problem-based visit can be performed and billed accordingly with any additional findings.
If the provider wants to do labs in the absence of any signs/sxs/dxs (oftentimes initiated by the pt who insists and providers just do what the pt asks), they MUST learn to associate EACH lab order with the correct associated Z screening code (e.g. Z13.6 Screening for CVD for a lipid panel 80061 or Z13.1 Screening for DM with an 83036 A1C test); however, not all "routine annual labs" have a screening code and not all payers honor them... or they have frequency limitations that need to be considered. So this is a HUGE provider education piece that we are still struggling with but slowly starting to see some improvement at some of our clinics.
I'm not sure if my rambling made sense or helped at all but I feel your pain and wanted to share what we've tried thus far. It's a long process but every time we see that screening z code on a lab order, it's a reason for us in coding to celebrate now!! Baby steps!
