Wiki GHP 80050 components with both medical and preventive dx

[SMorris13]

One of my providers ordered a 85025, 80053, and 84443 separately on a patient with commercial insurance. 80053 and 84443 were ordered under a preventive dx, while 85025 was ordered for monitoring of anemia. Since the payer requires these to be bundled as 80050, would we be able to bill the 80050 as preventive, or does it need to be under the anemia dx since the CBC as ordered that way? Haven't been able to find an answer on this so far! Thank you!

 

[danachock]

Hi SMorris13;
I understand your questioning, but in my opinion but if one part (even of three tests) was deemed diagnostic. They all are. Your facility will roll up 80053, 84443 with 85025 together into our ultimate "favorite 80050 panel".
If your facility doesn't have process and procedures in place to deal with this; NOW would be the time to address this, please.
I am trying to help, so forgive me if I come across incredibly pushy okay.
You need to pull in your billing staff to figure out ~ when is it appropriate to bill 80050 and not (it is EXTREMELY IMPORTANT to check your EACH AND EVERY SINGLE PAYERS POLICY HERE. (sweetly, please)
You need also claim editor (claims manager) help! Do they believe; that they you as a coder, have you thinking you know which one is appropriate or secondary diagnosis? I cannot state. I don't work there. I would be asking anyone that has any authority, supervisor first, department or specialty supervisor, and of course compliance. WE ALL KNOW THAT THESE ARE OUR SUPERIORS. I apologize, it is getting late, so let's chat on this tomorrow if anyone has something to offer okay. Respectfully, there should be edits in place from this research please.
Thank you for listening but this isn't my "coding rodeo" it is your facility's.
In my flat out opinion. Coding Supervisors should be seriously asking not only a coder what is wrong but also billing & goodness compliance, how to tend to it?
Hang in there please, I have arms up on how to proceed. Completely unsure!!
Thanks,
Dana

 

[SMorris13]

Hi SMorris13;
I understand your questioning, but in my opinion but if one part (even of three tests) was deemed diagnostic. They all are. Your facility will roll up 80053, 84443 with 85025 together into our ultimate "favorite 80050 panel".
If your facility doesn't have process and procedures in place to deal with this; NOW would be the time to address this, please.
I am trying to help, so forgive me if I come across incredibly pushy okay.
You need to pull in your billing staff to figure out ~ when is it appropriate to bill 80050 and not (it is EXTREMELY IMPORTANT to check your EACH AND EVERY SINGLE PAYERS POLICY HERE. (sweetly, please)
You need also claim editor (claims manager) help! Do they believe; that they you as a coder, have you thinking you know which one is appropriate or secondary diagnosis? I cannot state. I don't work there. I would be asking anyone that has any authority, supervisor first, department or specialty supervisor, and of course compliance. WE ALL KNOW THAT THESE ARE OUR SUPERIORS. I apologize, it is getting late, so let's chat on this tomorrow if anyone has something to offer okay. Respectfully, there should be edits in place from this research please.
Thank you for listening but this isn't my "coding rodeo" it is your facility's.
In my flat out opinion. Coding Supervisors should be seriously asking not only a coder what is wrong but also billing & goodness compliance, how to tend to it?
Hang in there please, I have arms up on how to proceed. Completely unsure!!
Thanks,
Dana

Thank you for your reply! To be honest, this is what my gut is telling me as well, but I wanted to hear another opinion on it before I committed.