Wiki Physical labs denied for DX Z00.00

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cmanion

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My office has always ordered our patient's blood work for a physical under the DX Z00.00. Recently, I have had several patients call and complain stating that they are being charged for their physical labs. The insurance company is telling them that the labs were coded wrong and that we need to rebill with a different DX so they will be covered. has anyone else dealt with this before Is there another DX that I can bill? I know that I can't just give them a random code to rebill, Is there anything I can do to help these patients? My office does not perform the labs so the lab billing is done by another department.
 
Hello Cmanion:)
Umm I might be able to help. So the patient gets annual physical but is the doctor checking their Vitamin D, Iron, urine to locate more data if pt is truly healthy or a hiding illness ? The provider needs to guide you better(query him or her) but I believe some providers feel the name of the lab test is defining or incurred what is being searched for. See examples of labs define what testing for link with dx searching these possible dx.
Lab Possible Dx
82306 82562 Vitamin D E63, E55 Z13.21 last dx
87070 81003 urines N28.89
87045 82270 fecal Z12.11 R19.8
84425 Vitam. B12 E53.8 D51.8
84484 thyroid E07.89
82728 Ferritin (iron) E61.1 or D50
However the provider is the expert and is suppose to give an lab order with better explanation. there are many lab test linked to differ dx codes. Also reviewing the CPT manual for lab gives some kind of clues too. I hope this data helps you.
Lady T :)
 
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It's hard to give a general answer without specifics. However, some lab tests may not be part of the patient's routine preventative benefit and would need a medically necessary diagnosis to cover.

(Those labs may also have patient responsibility, because they would process under the patient's diagnostic lab benefit.)
 
sls314 said:
It's hard to give a general answer without specifics. However, some lab tests may not be part of the patient's routine preventative benefit and would need a medically necessary diagnosis to cover.

(Those labs may also have patient responsibility, because they would process under the patient's diagnostic lab benefit.)
Click to expand...
The TSH, lipid panel, complete metabolic panel with fasting and the CBC are the tests that are most frequently being denied when billed with DX Z00.00. I'm wondering if screening codes would be more appropriate to use as the patient is healthy and has no current issues?
 
It just doesn't make sense to me that this would be ok for any of the labs: Encounter for general adult medical examination without abnormal findings
The labs are not an adult medical examination encounter necessarily, and there is a more specific reason they are being run... screening or monitoring a known condition.
I would direct you to read the ICD-10 official guidelines and also the code range chapter 21 instructions for definitive help.

This explains it well:

I agree with Susan, not all of them are covered under the preventive benefit.

I would also be careful of ..."always ordered our patient's blood work for a physical under the DX Z00.00". Surely not every single one is the same. You might not be billing the labs but you are ordering them and what is on the order matters.
 
Amyjph:)
Yes screening codes which are first listed dx Z codes can be used first on claim (see example dx Z01.89, Z01.818, Z51.11). I always use the Z code as 2nd dx used if related to rationale on labs ordered which provider give a reason why wanting this lab test or in conjunction with the patients illness/condition for the day's treatment. Always remember dx Z00.00 encounter without abnormal findings ..maybe another reason why denied. Ordering labs and nothing wrong??? Z00.01 states encounter with abnormal findings. . just a thought.
Lady T
 
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