Wiki Is reviewing Preventive Care lab results considered a Significant, Separately Identifiable service?

[kvr2112@yahoo.com]

The patient comes for a Preventive Exam (cpt 99396). In his note, the provider includes a status of the patient's chronic conditions based on his review of the lab work done one week prior, e.g. Hypertension, stable with meds; Diabetes, stable with meds. He then adds CPT 99214 to the 99396 as a Significant, Separately Identifiable service with a 25 modifier. Then the claim comes to me for coding review and I'm not sure that the" Significant, Separately Identifiable" qualification is actually met. Opinions?

 

[Cls1530]

Is he the one who ordered the labs? Is someone else treating those conditions? Are these normal preventive labs the insurance company includes in their preventive services?

 

[kvr2112@yahoo.com]

He ordered the labs and he is treating the conditions. They are normal preventive labs.

 

[kvr2112@yahoo.com]

Correction - the labs ordered to check on the patient's chronic conditions are NOT considered "preventive" labs. However, there were no abnormalities to address.

 

[kvr2112@yahoo.com]

Is he the one who ordered the labs? Is someone else treating those conditions? Are these normal preventive labs the insurance company includes in their preventive services?

He is the one treating the chronic conditions. The labs ordered to check on these chronic conditions are not considered Preventive, however there are no abnormal findings to address, e.g. adjust meds.