We have had a patient's "routine" lab work denied when billing diagnosis code V72.62. When I called Anthem BCBS they said that the patient does have routine benefits but the code I used is not payable. They said they follow the US Preventive Task Force guidelines and these could be found on their website. I looked on the USPTF website and could not find anywhere where they list acceptable routine diagnosis codes. Has anyone ever heard of this or guide me here? Thanks
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Wiki Preventive diagnosis code
- Thread starter Kathy615
- Start date
mitchellde
True Blue
what the reason for the lab? If it is for screening then you use a screening code, if it is because they are on a medication such as lipitor, or coumadin then use V58.83 and V58.69. It really just depends on the reason why the lab was ordered.
Well, more and more insurance companies are paying for what they call "routine lab work" once a year. So, If a patient has this benefit & has a diagnosis of hyperlidemia we will bill labs once a year as routine,V72.62. If because of their hyperlipidemia they have to have labs done in another six months we would use hyperlipidemia as the diagnosis. In a case like this we would never use a screening diagnosis because hyperlipidemia is established.
Has anyone ever referred to the US Preventive Task Force for a list of wellness or routine covered codes?
Has anyone ever referred to the US Preventive Task Force for a list of wellness or routine covered codes?
mitchellde
True Blue
I agree it is not screening. I have ever seen the US preventive task foce list, HOWEVER you should always code from the physicians documentation not form a list. If you patient has hyperlipidemia and has routine labwork it is usually due to the drugs that they are taking for the conition. Coding Clinics have visited this issue numerous time and the reason for the encounter is for drug monitoring so V58.83 with V58.6x is appropriate coding for this and it does communicate routine lab work.