I need to know if anyone has clear documentation on the following.

Patient present for physical exam and blood work is ordered, let's use the example of lipid panel. This particular patient already has a definitive diagnosis of 272.4-hyperlipidemia and has for some time. The patient's insurance covers a yearly physical and screening blood work, and wants to ensure all lab tests are ran as screening. However, our office has always stood by the fact that if the patient has a definitive diagnosis as in hyperlipidemia the lab test (lipid panel is this case) is no longer a screening test. I suppose what I am asking is if we are "allowed" to bill labortory tests as screening even if the patient already has a definitive diagnosis that would normally be detected by that particular test.

I have a similar issue with my general surgeon. Patient schedules appt for screening colonoscopy, during initial appt the physician mentions patient has constipation. The operative note lists preoperative diagnosis of constipation along with stating colon screening. Colonscopy is billed as diagnostic due to constipation, and patient later calls in upset because he came in for a screening due to his insurance paying 100% for screening colonscopy. I discuss with my physician and he feels it is his option to bill the colonscopy as either screening or diagnostic.

Would appreciate any feedback on both scenarios above.