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screening vs routine

  1. #1
    Default screening vs routine
    Medical Coding Books
    Ok - how do you determine if a lab is truely ordered due to a diagnostic reason or as a screening. As a biller I'm constantly getting calls - if you would file it differently my insurance says they will pay.
    Grey area - patient had history of something - not on meds - ???
    Or another posibliity Patient on meds for specific problem - such as high TG- when we recheck labs is it due to high TG or screening?
    As a biller - plus customer service person - my providers want me to figure out a way to make everyone happy - but my question comes back to soo often when labs are ordered it is sometime a grey world to me how to correctly code. If it looks reasonable to refile the opposite way I have refiled with records but really would like some ideas from experienced people how they did with the lab diagnostic issue.

  2. Default
    I too have this issue and would love to get feedback!

  3. Default Screening vs Routine
    What dx code should you use to indicate routine (preventive) lab work? Insurance companies usually pay 100% for routine labs

  4. #4
    Greeley, Colorado
    To start off, you should look at the following articles in The Coding Edge:

    May 2010 "Just Change the Code" by Simone Tessitore, CPC,COBGC
    November 2010 "Don't Change the Code" by Pam Brooks, CPC,PCS
    These are great articles! You are not alone in this dilemma.

    Next, check the notes and then query the provider. If the notes state "screening labs" V70.0 would most likely work. But if the patient has a pre-existing dx such as hyperlipidemia and a Lipid panel is ordered, it's not screening. The documentation must support the order for the test.

    I hope this is helpful.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Columbia, MO
    If a lab is ordered due to patient not having any symptoms or complaints then it is either to check drug levels or it is screening.
    So screening is a test ordered in the absence of signs and symptoms and there is no need to monitor. It is being ordered due to patient request or because it is prudent given the patient meets certain predetermined criteria. Sometimes payers will cover screening and sometimes not, we do not change the codes, the patient should know prior to the test if this is covered, and since it is screening there is no medical reason per se so they can elect to not have it performed.
    If the patient is on medication that makes it prudent and quality of care on the physician's part to order periodic testing to be certain the drug levels are within therapeutic range then this is not screening it is monitoring so it should be coded with the V58.83 fist followed with the V58.6x, and the condition requiring the drug can be listed last.
    Sometimes it is just impossible to make everyone happy, however the diagnosis is the patient's as rendered by the provider and we must always be 100% correct in our code to match the documentation.

    Debra A. Mitchell, MSPH, CPC-H

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