Wiki ICD-9 coding for lab tests to check for vitamin deficiencies

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ch81059

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Hi Everyone,

I have a question that I would like to get an opinion on if possible. I was auditing a physician's assistant for a general surgery practice. This practice performs weight loss surgeries. When patient's are required to be on a physician supervised weight loss plan before surgery will be approved, they come in to see them in 3 month and 6 month intervals, for some insurance it is more than that. For these visits they order lab tests to rule out whether or not the patient has any vitamin deficiencies prior to having weight loss surgery. The PA as well as some of the physicians are coding these visits with ICD-9 code 269.2 for unspecified vitamin deficiency. My lead told the PA that this could not be used as a diagnosis because that was not a definitive diagnosis. She told her that she should be billing for the morbid obesity and co-morbidities. She said that they don't use that because the insurance won't pay for the lab tests if those codes are used and they end up losing patients because they are charged for these tests and end up having to pay enormous lab bills out of pocket. My lead told her that this code still could not be used in order to get paid when it is not a definitive diagnosis. Has anyone had this issue and if so how was it handled? Also, if there is any other supporting documentation other than CMS guidelines, please include that also.

Thanks!:)
 
You cannot assign a dx code for a diagnosis the patient does not have. It is not so much that it is unspecified it is that it is yet to be determined as to whether the patient has any vitamin deficiencies at all. I would use a screening code scine they are in fact screening to see if a deficiency exists.
 
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