Wiki Ordered Labs with diagnosis V70.0

[jeaner54175@yahoo.com]

I am confused when it is appropriate to use V70.0 for labs ordered at an office visit or annual exam. I have a provider who uses V70.0 just about on all labs ordered but I thought we had to use a diagnosis (DM, hypertension, etc.) if they have been diagnosis with it or a screening code. Do insurance carriers cover those labs that were ordered with V70.0? Any advise would be great.

Thanks,
Lisa

 

[danachock]

V70.0 with Labs

Hi Lisa,
The V70.0 is just for the physical. Any laboratory tests done should not be coded with V70.0. Gently refer them to assigning V72.62 "if the labs are done as part of routine physical. However if your provider is assigning V70.0 to the physical, pap smear, colonoscopy, and all the labs then it may be time for some education especially if the patient has listed medical conditions that are being monitored.
I know from experience that BCBS will "typically" NRP the patient for the labs that are assigned the V70.0. I know that Medicare and a few others will not pay anything because "medical necessity was not met".
Is there something specific you are seeing?
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, and Laboratory Coder

 

[jeaner54175@yahoo.com]

Yes, I see V70.0 used a lot for BMP, CMP, lipids, PSAs, TSH, diabetes testing, etc.. and if there is a diagnosis in their chart I'd prefer to use that or a screening code. But my concern is some of our labs get sent out to an outside laboratory that same day and it might take a day or more for the encounter to come to me and I am afraid if the diagnosis gets changed on the encounter but the ones that are sent out to the lab remain the same the insurance company might red flag it. So I was double checking to see if my thinking was correct before I say anything.

Lisa

 

[erjones147]

Lisa,

I'm in the same boat as you and definitely feel your pain. What I do is to just change to code to the appropriate screening code (V77.1, V18.0 is a personal favorite, when applicable) and SO FAR have not have any problems with insurance (knock on wood)

V77.91 and V77.99 have also been life savers. A good family history helps a bunch