Wiki preventive labs

[adwood68]

Is anyone else out there noticing that some of the big carriers are applying preventive labs to patient deductible even when you bill correctly? Has anyone had great luck mastering this?

 

[LMSprankle]

I'm not a cpc yet and don't work for a provider just yet but i do work for an insurance company....i'll try to help as best i can though....

It is something that is quite common. When you say that you code it correctly that may be from your standpoint but what they are looking for is a routine dx code in the "primary" position (at least my company looks for that).

Typically the code they are looking for is V72.62 or something similar. Anything that refers to a special screening or something other than labs performed as part of a routine physical would automatically be applied to the deductible or OOP.

Hopefully that helps. I have so many members that contact us about this issue but we are not allowed to tell them how to code the claims....

 

[dclark7]

The U.S, Preventive Serivces Task Force has developed a list of recommended screening tests. If the test does not have a rating of A or B the insurance companies are not required to cover it. Also, if a person has been diagnosed with a chronic problem (high cholesterol, diabetes, etc) the tests are no longer considered screening they are considered surveillance. What does this mean for patients? Some things that may have been covered in the past for preventive exams are no longer covered. Here's alink to the USPSTF list of covered preventive services under the ACA. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm