Lead screening for well child exam

Bobby A

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Dittmer , MO
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I am getting denials for dx: Z13.9 from Anthem for a 1 yr old lead screening. I am looking at Z13.8, what are the rest of you using?

Thanks
 
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I am getting denials for dx: Z13.9 from Anthem for a 1 yr old lead screening. I am looking at Z13.8, what are the rest of you using?

Thanks

Is this being done as part of a routine well child visit? What CPT code(s) are you billing? Z77.011 would be "Contact with and (suspected) exposure to lead", but if it's just a routine check, it would just be included in the well visit DX.
 

vickytia13

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lead

Our practice does lead testing for 12 months and 24 months of age, but if the child has not had them done at that age we do two test before they turn 5 years old. We use the cpt code 83655 for the lead testing and 36416 for the finger stick draw with a ICD-10 code R78.71. None are getting paid. Anyone else having this problem? How can we get reimbursed for this?
 

mitchellde

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With documentation indicating lead screening and nothing further, the only code available is z13.89. you would not use the z77.011 unless there was definite documentation of a possible lead exposure or contact. you would not use R78.71 unless there was documentation that there has been a previous lead level detected. if there is a documented exposure then it is not a screening. most screening for this type of chemical is not covered.
 

HangarPilot

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We also do lead screenings at 12months and 24months of age. If done during the Well Visit, the Well Visit dx code is used. If done during another type of visit, we use Z13.88 for the screening code.

Medicaid pushes these screenings and we have had no problems getting them paid from the Medicaid HMOs... That being said, we have found most commercial insurances will not pay for them if done in-house. Those patients are sent to the lab. :(
 
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