AT2728
Expert
Here's our situation...
We have multiple patients who have a benefit of annual exam once a year paid at 100% through their insurance. Our patients typically want to have this performed when we would normally schedule their 6 month follow up for HTN/Hyperlipdemia-essentially getting a two for one deal. Our doctors continue to allow this to happen and have therefore, created a nightmare for our billing department. So, in this scenario patient comes in 2 days early for his labs--he states he is here for preventive labs, when the nurse views his chart the patient is due for his lipid and BMP for his HTN and Hyperlipidemia. The patient also has a PSA-billed as screening. We bill out his BMP and LIPID with his HTN and hyperlipidemia diagnosis as this is routinely done for monitoring and not as preventive--V70.0.
The patient is now irate and yelling at me because he wants his labs billed with a V70.0 even though he has clear indication for these tests being performed and requested by the MD for his HTN hyperlipdemia.
The only conclusion our office can think to come up with to avoid the labs being ordered due to the patients known conditions was to have the patients schedule strickly a preventive visits with labs being ordered and/or performed that same day and tied directly to that V70.0 preventive code. As I said, the patients essentially want a two for, their 6 month followup and labs done for HTN/etc along with their preventive and all of it billed as preventive with V70.0.
We have always stood by using their chronic diagnosis and not screening or preventive due to the fact that it is evident in thier visit note they have a condition that the physician monitors by specific lab tests routinely. Is it incorrect to just apply the V70.0 to labs tests even though they have a known diagnosis simply because they want it covered at 100%? The kicker here is that their insurance company tells them that we coded it wrong, and simply need to alter the code to V70.0 and they will cover it--its that easy to them....
We have multiple patients who have a benefit of annual exam once a year paid at 100% through their insurance. Our patients typically want to have this performed when we would normally schedule their 6 month follow up for HTN/Hyperlipdemia-essentially getting a two for one deal. Our doctors continue to allow this to happen and have therefore, created a nightmare for our billing department. So, in this scenario patient comes in 2 days early for his labs--he states he is here for preventive labs, when the nurse views his chart the patient is due for his lipid and BMP for his HTN and Hyperlipidemia. The patient also has a PSA-billed as screening. We bill out his BMP and LIPID with his HTN and hyperlipidemia diagnosis as this is routinely done for monitoring and not as preventive--V70.0.
The patient is now irate and yelling at me because he wants his labs billed with a V70.0 even though he has clear indication for these tests being performed and requested by the MD for his HTN hyperlipdemia.
The only conclusion our office can think to come up with to avoid the labs being ordered due to the patients known conditions was to have the patients schedule strickly a preventive visits with labs being ordered and/or performed that same day and tied directly to that V70.0 preventive code. As I said, the patients essentially want a two for, their 6 month followup and labs done for HTN/etc along with their preventive and all of it billed as preventive with V70.0.
We have always stood by using their chronic diagnosis and not screening or preventive due to the fact that it is evident in thier visit note they have a condition that the physician monitors by specific lab tests routinely. Is it incorrect to just apply the V70.0 to labs tests even though they have a known diagnosis simply because they want it covered at 100%? The kicker here is that their insurance company tells them that we coded it wrong, and simply need to alter the code to V70.0 and they will cover it--its that easy to them....