"screening labs" help please

TLC

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Our patients are getting bills for labs done as part of their physicals. Mostly for Vitamin D. How are you suppose to code for labs other than the Z00.00. Especially if the patient doesn't end up having any of the problems you are testing for. These tests are expensive, how do you know if someone has something unless you test them for it.
PS. we are also having a BIG problem with dexascans 77080. It looks like unless the patient has Osteoporosis, Cushing's syndrome, Osteopenia you can't do a screening Dexa. It looks those are the only codes they cover. What happened to being able to bill for , menopause, screening for osteorosis? Help please. Thank you
 

mitchellde

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Columbia, MO
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These are screening and should be coded with screening Z codes. Not all screenings will be covered and will be patient responsibility.
 

CodingKing

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Not all screenings are medically necessary. For instance here is a list from Medicare LCD on who is eligible for a DEXA to be covered:

- A woman who has been determined by the physician or qualified non-physician treating her to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other indicators.
- An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass), or vertebral fracture.
- An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of Prednisone, or greater, per day for more than 3 months.
- An individual with primary hyperparathyroidism.
- An individual being monitored to assess the response to or efficacy of an FDA approved osteoporosis drug therapy. This service must be performed using dual energy x-ray absorptiometry system (axial skeleton) – CPT code 77080.
 
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Loganville, GA
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So far the only way Vitamin D is covered is if they have Vitamin D deficiency. I've even tried the Z13.21 screening for nutritional disorder and it doesnt work either. I think I remember seeing on CMS if a pt has CKD ins will cover VIT D. As far as the bone density try screening Z78.0 for the women provided their are post menapausal for Medicare pts. Z13.820 I think is the actually bone density screening code. Still working on the men though. They have different criteria. However, on CMS I did find that if a pt has CKD, Vit D deficiency, and a few other diagnosis the bone scan should be covered but not at the prevention benefit pay.

Even on BCBS VIT D lab test isn't defined as medically necessary. But policy guidelines for BCBS Excellus state if pts have the following VIT D lab test will be covered: CKD, malabsorpton syndromes= Crohns, IBD, CF,African American and Hispanics. Osteoporosis, 3 mth or longer med use of steroids, antiseizure. Pts > 65 with Hx of falls or nontraumatic fractures. Obese children and/or adults with BMI > 30.kg/m. T

CKD MUST BE STAGE 3 OR HIGHER
 
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