Wiki Coding Question/dilemma

[karen.hull@hotmail.com]

I am coding labs relevant to wellness exam for a patient. The doctor ordered CMP & Lipid. Code V7262 was assigned as principal dx. Order for Lipid & CMP dx was screening. In checking patient record, prior dx of hyperlipidemia has been assigned plus patient was on meds (statin) for this. In querying dr re dx of screening for lipids and CMP, dr said he ordered the labs prior to the wellness exam as screening, and then when the patient presented for the wellness exam, labs were reviewed, and dx of hyperlipidemia was assigned. He wants the dx for the labs as screening. The record does not support this because of prior dx and past history. What would you do?

 

[Pam Warren]

Per ICD-9 coding conventions, "V72.5 and V72.62 may be used if the reason for the patient encounter is for routine lab/rad testing in the absence of any signs, symptoms or associated diagnosis". (underline my emphasis)

Code the hyperlipidemia. This is not a screening lab, it is a surveillance lab.

 

[karen.hull@hotmail.com]

Question/dilemma

Thank you Pam. That is what I did and I am getting "heat/push back" from the doctor, patient and now our Administration (CFO). They want it coded as the doctor ordered. I am having trouble doing that, so your answer helps a lot. Thanks again

 

[mitchellde]

If the labs are being performed just because the patient is on treatment for the condition then Coding Clinics state to use the V58.83 and the V58.6- code for the monitoring of the condition because the patient is on medication. However it is not screening when you know the patient already has the condition.