Internal Medicine Coding Alert

Question: A physician wants to prescribe medication to a patient with systemic lupus erythematosus (SLE) that could possibly be toxic to the liver. So a liver function lab test will be run on the patient to make sure he doesnt have any liver problems before he starts taking the medication. If the patient doesnt have any signs or symptoms of liver disease and no past personal or family history of liver disease, is the liver function lab test considered a screening test? Should the diagnosis code for the lab test be SLE or should a V-screening code be used?

Laura Haugen
St. Louis Park, Minn.

Answer: A screening test is done for asymptomatic patients, which means there is no medical necessity for the test. A diagnostic test is for patients with symptoms. Because the medication is known to possibly be toxic, there is medical justification to run the liver function laboratory test. In this situation it would be considered a diagnostic test and not a screening test, according to Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a medical practice consulting firm in Broomfield, Colo. It is considered medically necessary for the physician to obtain test results that play an integral part in the managing of the patients condition, she explains. Therefore, the liver function lab test is not considered routine screening. Code 710.0 (systemic lupus erythematosus) may be reported as the reason for the test.