Preventive Coding on Lab Orders


Three Rivers, MI
Best answers
Have a provider who orders labs prior to well exam appointment.

She will not use the zoo.oo code. Instead, uses screening codes on the lab order. This often leaves a very large balance for the patient.

Can she use the zoo.oo code on her lab order prior to the preventive exam being done?
There are many carriers that will not accept the Z00.00 for labs. If it is truly screening then the screening Z code is correct. If the patient has a chronic condition and is on medication that requires monitoring then use drug monitoring. Not all screenings are covered services. You need to advise the patient to check their preventive benefits to determine which screenings are covered, the others the patient can opt out of having performed or they can accept that they will be patient responsibility.
The biggest carriers we deal with are Blue Cross and Priority Health.

I believe she uses the screening codes due to the fact that she is ordering the labs prior to having provided
the medical exam. (She likes to have the lab results at the exam to discuss with the patient) and she is not comfortable using a diagnosis code for a service she has yet to provide.
If the patient does not have the diagnosis and is not being treated for the chronic condition, then it is screening and that is the appropriate coding. However the patients do have the ability to refuse any testing if they are made aware before hand that they will be responsible for the bill. if they are not informed of the nature of the testing, and it is discovered that the screening is not covered, then you will have difficulty collecting the payment from the patient.