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.
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