snwhite0730
Contributor
Hello Coders,
I am hoping someone can give me a little guidance on billing/coding labs ordered during AWV/CPE visits. I have two scenarios that are giving me issues and we are getting denials for routine labs ordered during well visits. What I really need to know is can I link the diagnosis given in the assessments with the labs the MD ordered if the documentation only list Annual Wellness Exam, if I have conditions/diagnosis that will cover medical neccessity?
1. With the AWV/CPE labs the providers just list ALL of the labs under the Z00.00 code in the treatment portion of their documentation. As we all know Z00.00 doesn't cover labs so we are getting denials for all of the labs the providers are ordering. If the providers list other diagnosis/conditions in their documentation that support medical necessity , as a coder can I link the diagnosis to the appropriate lab?
2. How are you all handling visits for just lab draws if the MA's are not listing codes or only placing the Z00 codes?
I can't find anything that says for sure that the coder can or cannot link diagnosis to labs and it's driving me a bit crazy. The MD's list diagnosis in the chart, the test they ordered would be supported by that diagnosis (i.e. AWV MD orders CBC. Pt has a diagnosis of I10 which covers medical necessity) but he doesn't directly link it in the documentation. How does this work? Can I add codes to the lab procedures that will cover medical neccesity? or is this the same as with coding the charts and I cannot assume he needs the test for that reason and we have to keep the labs under the Z00 code because that is how the provider listed it in the chart?
I am hoping someone can give me a little guidance on billing/coding labs ordered during AWV/CPE visits. I have two scenarios that are giving me issues and we are getting denials for routine labs ordered during well visits. What I really need to know is can I link the diagnosis given in the assessments with the labs the MD ordered if the documentation only list Annual Wellness Exam, if I have conditions/diagnosis that will cover medical neccessity?
1. With the AWV/CPE labs the providers just list ALL of the labs under the Z00.00 code in the treatment portion of their documentation. As we all know Z00.00 doesn't cover labs so we are getting denials for all of the labs the providers are ordering. If the providers list other diagnosis/conditions in their documentation that support medical necessity , as a coder can I link the diagnosis to the appropriate lab?
2. How are you all handling visits for just lab draws if the MA's are not listing codes or only placing the Z00 codes?
I can't find anything that says for sure that the coder can or cannot link diagnosis to labs and it's driving me a bit crazy. The MD's list diagnosis in the chart, the test they ordered would be supported by that diagnosis (i.e. AWV MD orders CBC. Pt has a diagnosis of I10 which covers medical necessity) but he doesn't directly link it in the documentation. How does this work? Can I add codes to the lab procedures that will cover medical neccesity? or is this the same as with coding the charts and I cannot assume he needs the test for that reason and we have to keep the labs under the Z00 code because that is how the provider listed it in the chart?