Wiki Rookie Questions about getting labs covered in ambulatory setting

[krauttermedicine@gmail.com]

What diagnoses codes are you seeing work (I know they vary among insurances) for covering lipid panels, TSH panels, and A1C panels? Screening codes are variable it seems. I feel like this is a common question, but the longer we do this, the more questions we have. For example, if a patient is presenting with chronic fatigue, and provider suspects or at least want to rule out a thyroid issue, what code would you use that usually gets covered? Thanks!

 

[TThivierge]

Hi Krauttermedica
I use notations for doc's order to guide me but at times the name of the lab is what the physician is looking for. Also if person has complex illness like type of cancer and it is current most labs will coordinate with such serious illness. Also do not forget to code in lab panels per the regulations and CPT list.

Here are my standards lab test our providers use & coordinating dx. However each patient has own doc s order maybe different depending on reasons for treatment for the day.
84484 Thyroid Dx Blocks E07.89, E21.4, R94.6 E03 or E05 E78.5
82306 Vitamin D Dx Blocks D51.0 E55.9
81003 Urinalysis Dx Blocks N28.89 E11.9 N40 R39 N39 i10
84425 Vitamin B Dx Blocks D51.8 E53.8
86363 A1C Dx Blocks E11.9 R73.30 E03
85610 PT Prob time Dx Blocks R79.1 z79.99
82270 occult blood feces Dx Block Z12.11 r19, R15 K92
84153 Prostate Dx Block N42.9 R35
84402 Assay Free Testosterone Dx Block E29.1
84132 Potassium Vit K Dx Block I10 E56.4
86039 ANA Antibodies Dx Blocks D89.89 M63.8 E70.29 M32.8
Can link lab panels with type of encounter care as last dx blocks of Z11, Z12 and Z13 at end. Can also can use Z01.89 as first listed dx

I hope helped you
Lady T

 

[TThivierge]

What diagnoses codes are you seeing work (I know they vary among insurances) for covering lipid panels, TSH panels, and A1C panels? Screening codes are variable it seems. I feel like this is a common question, but the longer we do this, the more questions we have. For example, if a patient is presenting with chronic fatigue, and provider suspects or at least want to rule out a thyroid issue, what code would you use that usually gets covered? Thanks!

Krautter
Did this data help you at all?
Lady T