Wiki Health Screening Help

[sprevatt]

How would one code the screenings? What CPT codes and dx would you use for these on one claim?
BMI - Body Mass Index
Blood pressure screening
Glucose Screening
Lipid Screening

 

[Pam Warren]

It's not that simple. Sorry!

BMI is a Diagnosis code. There's no specific CPT code for determining BMI. Medicare does have obesity screening codes, but the documentation is specific, check with CMS and your local contractor. BMI diagnosis codes are in the V-code section of ICD-9, and it depends on the measurement and patient age. Kids are coded based on the growth curve. If the BMI has been determined, you can code that, but if it's a screening and you don't have a definite BMI measurement (or the physicain has not diagnosed obesity) you can use the screening codes (V77.8, screening for obesity).
BP checks/screenings are done usually as part of an E&M, or you can bill a simple BP check as a 99211 if all of the incident-to rules are met and if no other E&M was done on the same day. The diag depends on whether the patient has a previous HTN diag, or just shows elevated BP. If no issue, use V81.1, screening for hypertension.

Both glucose screenings and lipid screenings do have lab CPT codes associated, if you are providing those services. If the patient has a known symptom or condition, use those ICD-9 codes, if not use the appropriate screening codes to report the services.

 

[sprevatt]

Thank you

This is how the clinic is billing currently:
99402 - DX V81.1 and the appropriate BMI diag
82947,QW V77.1
80061,QW V77.91

The payer wants the diag indicators to allign with the procedure code. There is a grey area around billing the 99402 with just these 2 dx codes. NP are performing the service.