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v code or diagnostic icd-9

  1. #1
    Default v code or diagnostic icd-9
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    I really need Help on this anybody..
    I want to know what would be the dx code for this example:

    Patient is an exisitng patient has been previously diag with high cholesterol
    the patient needs to see the dr every 6m for med refill and blood work per the dr request.

    what dx code would be used 272.0 or a screening example v77.91?????

    patient stated that the insurance would pay if it was a routine dx code but since we used 272.0 they will not pay?

    also per the patient the insurance rep told her that because we know she has the high cholesterol that we should not be trying to dx her. I told her that we use the dx code because we are managing the meds? is this right?

    please someone explain to me if this is right
    Thank You...
    Brenda Amaro, CPC

  2. #2
    Hartford, CT
    You are correct, the reason the patient is being seen is because she has high cholesterol. The doctor is not "trying to diagnos her", he already has. You don't mention if she is on any meds for this, but if she is the doctor is ordering blood tests to see if the meds are effective and to monitor for any problems that might develop from the meds. He is not screening her, he already knows what the problem is.

    My experience is that the insurance reps tht the patients deal with are primarily customer service reps without much if any medical background. I have also found that there is not very much communication between the different departments, so the provider reps have no idea what the patients ar being told and vice versa.

    Also, the providers ofice has no control over the patient's benefits. The claims are not supposed to be coded primarily for reimbursement, but to explain why the patient was seen. The only time coding should come into play is if it was incorrect to begin with, codes can't be changed because of the particular policy a patient has.

    Hopes thsi is a little helpful.

    Doreen, CPC

  3. #3
    Columbia, MO
    I think the appropriate code when you are checking blood levels is V58.83 encounter for therapeutic drug monitoring, using the V58.69 secondary and then the reason for the drug third. Coding clinics also state this is the appropriate coding for this scenario.

    Debra A. Mitchell, MSPH, CPC-H

  4. Smile
    You have already diagnosed her which is 272.0, you should not have to use any other codes unless the doctor specifies any other diagnosis' on that visit. Perhaps a monitoring patietn on meds V code, but even that is not necessary. The patient is not being told the correct information, and there is no reason why the visit should not be paid as long as the diag and billing part on your side is correct, which it is. In my experience, you can call the insurance company three times and you will get 3 different answers. You are correct in your method. No V code or screening code is needed.

  5. #5
    Thank you all Doreen, Debra, and Schows this really help. We have always done it that way.
    But this last patient really got me thinking and I thought I maybe doing this wrong all along.

    we do use the v58.61 when we do PTINR.. checks or if a patient has been taking meds for a long time and we do liver check then we will use v58.69.

    But when we do the actual blood work for lipids or glucose and they have been diag then we use it corresponding dx code.

    Debra- and yes we have always had problems with the insurance reps telling patient " call your doctors office they coded it wrong" I hate that because then the patients insist that we did it wrong.. I then do a three way and have the providers rep explain to them how they we told wrong...

    But once again thank you to all...
    Brenda Amaro, CPC

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