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6mo lab work dx code for labs

  1. #1
    Default 6mo lab work dx code for labs
    Medical Coding Books
    okay i want to know what the people out there think of this?

    if a patient comes in for there 6mo check up and they do have an on going condition like 272.0, or 250.00 or something like that they are being treated for.. but the dr requires that they have a check up every 6mo regardless if they are feeling good or not. what would the dx codes be on the labs?

    V70.0, 272.0, 250.00
    or
    272.0, 250.00????
    Brenda Amaro, CPC

  2. Default
    why are the labs being done? As a check for the ongoing medical problems, or just as a routine? From what you've said, sounds to me like it's for followup on the ongoing medical condition and that would be your diagnosis.
    Carol, CPC, RHIT

  3. #3
    Default
    yes it is a follow up as an on going condition that they have. But we have a lot of patients that will say ( but my insurance covers routine labs)

    i guess my question is what does routine really mean?

    We have always used it where when they come for their follow up we use the medical dx code of what the reason for the follow up is, like you stated.

    But then we wil have patient calling stating "but I have routine lab coverage". So i am super confused I was double guessing my self like are we doing something wrong.
    Brenda Amaro, CPC

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by BRENDA28 View Post
    yes it is a follow up as an on going condition that they have. But we have a lot of patients that will say ( but my insurance covers routine labs)

    i guess my question is what does routine really mean?

    We have always used it where when they come for their follow up we use the medical dx code of what the reason for the follow up is, like you stated.

    But then we wil have patient calling stating "but I have routine lab coverage". So i am super confused I was double guessing my self like are we doing something wrong.
    Hi Brenda,

    I'm going to put on my insurance hat (15 + years with the Blues, 8 years with another insurance company). When writing/building the "routine" benefits for insurance, they mean "without evidence of disease or dysfunction". Although the patients will usually call these routine, the way to think of them is as preventive (or preventative).

    The most usual routine or preventive labs are, of course, a yearly pap for women, and a PSA for men over 50. There are a number of companies who, as part of the preventive benefits, are now covering other screening tests such as glucose and cholesterol. These are usually on a schedule according to age, and only every so many years. For example, my personal health insurance covers both of those tests every 5 years up to age 50, then yearly after that, with no disease or symptoms (in other words, a "routine" diagnosis). They are covered at 100% with no deductible. However, once the patient has a diagnosis of hyperlipidemia, and is either placed on medication or tries to lower it by diet and exercise, further cholesterol testing is no longer preventive or routine, but because they have a condition. The tests are probably covered, but subject to deductible and coinsurance.

    In your examples above, the patients have diagnoses that are the reasons for the lab tests, and it is correct to use those diagnoses, not a "routine" one.

    This is often a hard concept to explain to patients, so I hope this helps somewhat.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Default
    Hi Cindy-

    Thank you so much. Yes this really helps That is what I have always thought.. And we have been doing.
    But you know sometimes you get those patient that make you think twice about how things are being done.. and well they got me this time. But thank you very much your information was extremly helpful.

    Thanks Again,
    Brenda Amaro, CPC

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