AAPC - Back to school
Results 1 to 4 of 4

Thread: Request screening test with known diagnosis-What stance do you take?

  1. #1

    Question Request screening test with known diagnosis-What stance do you take?

    AAPC: Back to School
    This has been an issue for many years, but now thanks to Healthcare regulations, we are seeing this more and more. I would like to know what other offices are doing.

    Patients are presenting requesting a preventive appt with screening laboratory tests, their insurance covers lipid, HGBA1C, etc, once a year at 100%. The problem, the patient is a known diabetic, with hyperlipidemia. These tests are no longer screening for conditions as he has a known condition-clearly documented throughout the years. We have, in the past, informed patients that these tests can not be billed as screening, due to the known condition.
    What is your office doing in these instances? Would it be appropriate to use a screening diagnosis or v70.- code even if they have a known condition? Is it fraudulent to leave off their known condition when billing related laboratory tests?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    You are correct these cannot be screening, if these tests are being performed because the patient is taking medication that needs to be checked then use the V58.83 and the V58.6x code for the test. You cannot indicate a reason for a test that clearly does not exist.. you cannot be screening for diabetes if the patient has diabetes and so on.. fraud? probably but certainly misrepresentation of the circumstances and cannot be supported by the medical record. Don't do it!

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    I appreciate the reply. This has been our stance from both a billing and laboratory standpoint. Getting our physicians on board has been a bit more difficult, and of course, the patients speak directly to the physicians who inform them it will be taken care of. I just need some advice and opinions from others as I forsee this becoming more of an issue.

  4. #4


    to order a screening test really needs a V code stating you are screening for that particular disease, if they have been dx with it, are on medication for it, it is no longer a screening and insurance companies will deny a screening lab with a definitive dx...the same as if you order a diagnostic lab or xray with a screening dx....hope this helps.

Similar Threads

  1. Phychologist and LCSW allowed to request lab test - drug sreens
    By JWINGES in forum Pathology & Clinical Laboratory
    Replies: 0
    Last Post: 10-08-2014, 07:13 AM
  2. Stryker Recall Hip initial lab request diagnosis
    By creeves in forum Orthopaedics
    Replies: 1
    Last Post: 05-08-2013, 10:09 AM
  3. Replies: 2
    Last Post: 01-24-2013, 06:59 AM
  4. Signature Requirements for Laboratory Test Request / Orders
    By borr254 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-03-2008, 11:35 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.