Wiki what diagnosis code used when ordering blood work with a physical exam

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jordway

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Patient seen for a yearly physical and bloodwork is ordered. We were always billing the bloodwork with the diagnosis that realtes to the lab if they are already diagnosed. Ex Tsh with hypothyroidism and if no condition we would bill the screening labs. Patients are calling in angry that they are getting billed for the labwork that has a diagnosis other than screening. How should we code this?? Can we use the screening code for all labs ordered since it is being ordered at their physical??? Patients are telling us the insurance says it pays 100% if ordered as screening??
 
Our office will use V72.62 when the labs are ordered either before or after the actual appointment. If the labs are ordered at/during the Preventive appointment we will use
V70.0. And if the patient has a DX we will add that DX as a 2nd DX to further support that we are requesting these labs at the Preventive visit for routine testing but the patient does have this chronic condition.

The actual DX should be used if the testing is ordered for treatment purposes.

I hope this helps.
 
If the patient us on medication for a condition then the labs are to see if the treatment is successful, then use V58.83 with the appropriate V58.6- code secondary. If the patient does not have the condition but meets appropriate criteria for screening then use the screening code. If none of these conditions are met and it is performed as a routine, just because then use the V72.62
 
I used to see this issue (pts having to pay more for labs or pay from deductible, if labs were billed with a problem diagnosis rather than with V70.0). I have decided to order "standard routine labs" with V70.0, even if they could be billed to another relevant diagnosis. I usually am billing that other relevant diagnosis (DM, Htn, etc), so I am not hiding from the insurance company that I am seeing the pt for E/M as well as Wellness.

No complaints from insurance companies, so far as I know.

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jordway said:
Patient seen for a yearly physical and bloodwork is ordered. We were always billing the bloodwork with the diagnosis that realtes to the lab if they are already diagnosed. Ex Tsh with hypothyroidism and if no condition we would bill the screening labs. Patients are calling in angry that they are getting billed for the labwork that has a diagnosis other than screening. How should we code this?? Can we use the screening code for all labs ordered since it is being ordered at their physical??? Patients are telling us the insurance says it pays 100% if ordered as screening??
Click to expand...
 
davidinasheville said:
I used to see this issue (pts having to pay more for labs or pay from deductible, if labs were billed with a problem diagnosis rather than with V70.0). I have decided to order "standard routine labs" with V70.0, even if they could be billed to another relevant diagnosis. I usually am billing that other relevant diagnosis (DM, Htn, etc), so I am not hiding from the insurance company that I am seeing the pt for E/M as well as Wellness.

No complaints from insurance companies, so far as I know.

&&&&&&&&&&&&&&&
Click to expand...


Maybe not, but I don't think it's appropriate and correct coding. What you're suggesting is that we code specifically for payment---not following the coding guidelines.

If the patient has a condition (i.e. diabetes) and the lab work is ordered because the provider wants to see if their medications are working, you'd use codes from the V58.xx range. If they are not on medication, you'd code the disease. If they have no specified condition, but you are trying to get diagnostic verification, you code the patient's symptoms. If there are no symptoms, and the labs are entirely for screening (in preparation for, or during the preventive exam), you'd code V72.62. V70.0 is for a preventive exam, and with V72.62 being more specific, you're not following correct coding guidelines if you use V70.0.
 
Pam Brooks said:
Maybe not, but I don't think it's appropriate and correct coding. What you're suggesting is that we code specifically for payment---not following the coding guidelines.

If the patient has a condition (i.e. diabetes) and the lab work is ordered because the provider wants to see if their medications are working, you'd use codes from the V58.xx range. If they are not on medication, you'd code the disease. If they have no specified condition, but you are trying to get diagnostic verification, you code the patient's symptoms. If there are no symptoms, and the labs are entirely for screening (in preparation for, or during the preventive exam), you'd code V72.62. V70.0 is for a preventive exam, and with V72.62 being more specific, you're not following correct coding guidelines if you use V70.0.
Click to expand...

Pam,
Thank you for the clarification. I have been trying to find this exact information!
 
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