Wiki coding for labs

Create Wiki Sort by date
N

NIKI01

Networker
Messages
44
Best answers
0
Hello,

I am looking for some help with coding for blood work.
70 y/o male came in for blood work. Primary physician ordered:
CBC and differential
Comprehensive metabolic panel
Lipid panel
Hemoglobin A1c
dx. Routine adult health maintenance.

my gestion is -- how this should be coded? I coded as Z00.00 because only Z00.00 was documented on requisition and there weren't provider notes linked to the requisition. However, billing dept wants me to add Z13.6 for Lipid panel. Billing dept said:

1691605673237.png

I am looking for guidelines to support coding; however, I cannot find anything. Can you help please?

thank you for any help!
 
1
Hello NIKI01,
NO, I absolutely and wholeheartedly disagree; how do you get from routine adult health maintenance Z00.00 to Z13.6? If it isn't documented? If a RAC audit occurred, I am not the betting type but believe that the documentation you provided would not suffice for assigning Z13.6 in my opinion.
The billing department is sending you a coding inquiry because they know that Z13.6 is a coverable diagnosis and they do not want to add a GZ modifier to that charge and is asking you to "re-review". Been there and have clearly done that! Please be responsible, does the documentation state "Encounter for screening for cardiovascular disorders"? I didn't see that stated from your post. Unless it was omitted.
This is a huge, many years trend, all of our providers want to make everyone "happy", so they assign Z00.00 to everything. It doesn't matter if patient's have whatever medical condition, they have all those smart texts to obtain diagnosis codes. This is clearly a provider training opportunity. You cannot give Z00.00 to a patient with hypertension or diabetes or otherwise. They are overwhelmed and are picking the diagnosis codes that they feel will please everyone. Medicare hates Z00.00. You write those charges off all day long and strong with Z00.00.
As a coder you review documentation, AND the lab results from the Clinician's on their interpretation(s) and code appropriately. Did you review the results to see if the clinician reviewed it?
You may not assume one diagnosis code correlates with another.
I have been in this pathology/laboratory rodeo for too long to make those assumptions based on our ICD guidelines. (I am clearly not a provider, only a coder).
IF anyone has otherwise; I am completely all ears on this, but I am reviewing my ICD book on my kitchen counter, and I do not see the translation between Z00.00 to Z13.6. So please do educate me.
Thank you for listening,
Dana
 
0
Hi Niki101,
There is a list of first listed and screening codes encounter Z dx codes may help you too when doing lab. Dx Z13.6 is a screening code and it can be first on claim to signify the lipid panels but better if last dx code. Maybe can use E78.0 or E78.2 if related to documented patient s problems. Also view the doctor's order on lab requisition see what he or she marked to what illness searching for or is monitoring.
I hope helped you
Lady T
 
Last edited:
0
Hi Lady T
Thank you so much for your replay. I am still confused.
Dr. documented Routine adult health maintenance only on requisition and there is no additional dx listed on requisition and there is no dr. notes linked to the requisition. can Z13.6 be coded because provider ordered "Lipid panel" test?
 
0
danachock said:
Hello NIKI01,
NO, I absolutely and wholeheartedly disagree; how do you get from routine adult health maintenance Z00.00 to Z13.6? If it isn't documented? If a RAC audit occurred, I am not the betting type but believe that the documentation you provided would not suffice for assigning Z13.6 in my opinion.
The billing department is sending you a coding inquiry because they know that Z13.6 is a coverable diagnosis and they do not want to add a GZ modifier to that charge and is asking you to "re-review". Been there and have clearly done that! Please be responsible, does the documentation state "Encounter for screening for cardiovascular disorders"? I didn't see that stated from your post. Unless it was omitted.
This is a huge, many years trend, all of our providers want to make everyone "happy", so they assign Z00.00 to everything. It doesn't matter if patient's have whatever medical condition, they have all those smart texts to obtain diagnosis codes. This is clearly a provider training opportunity. You cannot give Z00.00 to a patient with hypertension or diabetes or otherwise. They are overwhelmed and are picking the diagnosis codes that they feel will please everyone. Medicare hates Z00.00. You write those charges off all day long and strong with Z00.00.
As a coder you review documentation, AND the lab results from the Clinician's on their interpretation(s) and code appropriately. Did you review the results to see if the clinician reviewed it?
You may not assume one diagnosis code correlates with another.
I have been in this pathology/laboratory rodeo for too long to make those assumptions based on our ICD guidelines. (I am clearly not a provider, only a coder).
IF anyone has otherwise; I am completely all ears on this, but I am reviewing my ICD book on my kitchen counter, and I do not see the translation between Z00.00 to Z13.6. So please do educate me.
Thank you for listening,
Dana
Click to expand...
Hello Dana,

Thank you so much for your reply, Dana! It was very helpful.
I only had a requisition for this patient without any additional documentation linked to the requisition. I emailed billing department to contact the provider for addition dx. I am still waiting for their response, as we do not email providers.

I was researching and I found this article with guidelines.

 
Last edited:
0
I am having this issue a lot at my organization, im still fairly new and cant find too much info. Providers are requesting labs as part of their annual physical i guess for screening the patient in many aspects and the insruance denies the Z00.00
 
You must log in or register to reply here.
Top