Wiki Labs for condition completed at time of preventive physical

JSoward

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Please help!!!
I work for a clinic in which it has been directed that labs for a condition be coded with the Z00.00 diagnosis as primary and the condition is secondary when the labs are being completed at the encounter for an annual preventive physical. Justification is to let the insurance company know that the lab was completed at the time of the patient's preventive visit, and then run for the condition. From what I understand, this came about because insurance companies were informing their clients that the lab was not coded correctly - or not coded with a preventive dx, essentially making the member liable for the labs run for a condition - and then patient complaints......

I have tried to clarify coding guidelines of what is considered screening versus diagnostic - per CMS guidelines. And now I have received a list of labs that are considered "normal" preventive services. I tried to clarify that the list of preventive labs is correct, but the diagnosis is still driven by the "why" and not the "when" for the reason for the service.

I am really concerned that my guidance from the clinic is going to be to continue to report these labs run for a condition at the time of a preventive annual physical with the Z00.00 as primary, because it will be a service to our patients to have it run through the insurance company software as preventive. But is that really wrong if the second dx is the condition - also informing the insurance company of that condition? Why can't I code it according to CMS guidelines and the insurance company then take the responsibility to link it to the member benefit plan?

Please - someone guide me as to what I can do? It also appears that this is a very long debate among coders. From the AAPC Healthcare Business Monthly August 2018 Issue, it very clearly stated (pg. 33) not to be led astray for diagnostic services run with a preventive annual visit. It even mentioned the F word. I just want to do the right thing.

JS
 
Labs with PE Physicals

Hello,

At my previous job billed labs with preventive physicals but usually the patient arrived for a annual physical CPT Code 99396 linked wiht the Z00 diagnostic code. If injections/vaccinations must be linked to proper Z diagnostic code. Any lab screening test should be linked to a definitive ds. or a Z code. If the patient has a chronic condition and physician documents it add it on the dx. listed. Also sequence the CPT codes properly and add modifier 25 if necessary as additional lab or injection required during the visit.

Also becareful of fecal blood card given to patient. Note it on medical record but should not bill till test results brought back and tested, just cause doc or nurse gave them the fecal card test cannot bill it. Just saying..this was process in our office

I hope this info helps you.

Lady T
 
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