# lab coding with V70.3



## nkoons (Jan 14, 2013)

I have patient's that come in for their yearly wellness physical and our physicians want to order lab work or diagnostic tests. On the order the physician writes wellness physical. In our office for a wellness visit we use either code V20.2 or V70.0 depending on the age. When this is written on the order, our hospital is using code V70.3. It seems that we are interpreting these codes differently. Should Wellness Physical even be on the order? I have been told to eliminate the Wellness from the order because the actual reason for the lab/tests is screening. What code would you advise? I have looked at code V72.62 Laboratory examination ordered as part of a routine general medical examination. But, I was question about using this from a complience stand point. Can I please have some thoughts on this?


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## Pam Brooks (Jan 15, 2013)

V72.62 is the code we use for lab work ordered as part of a routine physical. However, if the provider is ordering lab work for surveillance of a previously diagnosed illness or condition, you would use that code. For example, if the patient is diabetic and the provider ordered a HgA1C, then you'd append 250.xx as the diagnosis code. Also, if the patient has symptoms, and the provider is doing lab work to rule out or investigate a possible disease, you'd code the symptom. For example, if the patient has gained a significant amount of weight, and the provider wants to rule out hyopthyroidism by ordering a TSH, then you'd code the weight gain (783.1). Just because labs are ordered at the time of the physical, doesn't mean they are screening or preventive labs. According to the official ICD-9 guidelines, _"V codes allow for the description of encounters for routine examinations, such as a general check-up or examinations for administrative purposes, such as a pre-employment physical. The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used." _


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## mitchellde (Jan 15, 2013)

If the labs are ordered because the patient has a previously diagnosed condition , you do not use that condition as a reason for lab if the patient is under treatment for that condition.  You use the V58.83 and the V58.6x code for the lab.  For a diabetic controlled with insulin the lab would be V58.83 and V58.67, the 250.xx could be a third listed code.  Some labs are screening and should be coded that way, and some may be due to symptoms.  There is not one answer for all wellness visits.


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## nkoons (Jan 15, 2013)

Thank you  both. This helps. While I understand the issues with screening vs. diagnostic, my biggest conern is how the lab work is coded for screening. If the patient is in for their yearly physical and is disease free and symptom free, what code should be used for the lab work. Our hospital uses code V70.3 if wellness physical is written on the order. I only use this code in the office for sports or emplyment physicals. Insurance denies this code quite frequently. I am trying to find information to help justify why I feel that we should be using another dx for lab work, other than V70.3, when it is related to a yearly wellness exam. Also, many times the provider will just write the word screening and then it is coded as V82.9. I am thinking that the provider's need to be more descriptive. Screening Cholesterol, Screening Diabeties ect.. Any further suggestions?


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## mitchellde (Jan 15, 2013)

you are correct.  The patient's benefits may cover many different screenings and others they will not cover.  By not using the specific screening code they are not allowing the patient to access their benefits to the fullest extent.


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