Wiki Labs done with CPE

[Lindsey_McBee]

Our physicians often do labs with the preventive exams. Some of the labs will only have a screening Dx but some labs will have both the screening or routine Dx in addition to a medical diagnosis. The Docs say they are trying to keep everything under the preventive benefit but in my opinion if a patient has a confirmed diagnosis of diabetes or cholesterol problems then that should be the diagnosis on the claim.
Example
Preventive Visit w/ V70.0
81003 w/ V70.0 AND 401.1
93000 w/ V70.0 AND 401.1
80061 w/ V70.0 AND 272.2
What would you do and how would you discuss this with the physicians?

 

[Kiana]

If you are performing labs to confirm or get a dx then it should be coded as a screening, if you have a dx ie diabetes or cholesterol and you're doing labs for tracking to titrate maintenance medications, which they are usually on, then you need to code the signs & symptoms and dx. If you don't have a confirmed dx but the physician is running labs to zoom in on a confirmed dx then code signs and symptoms.

 

[JWESS]

I agree. If there is a medical reason that is warrented that is why the testing was done. Some of the patients do not like this answer if there benefits only cover preventative. However the example i always use is just because you are here for a physical does not mean you would use screening for a glucose if you are already a confirmed diabetic.