Wiki Lab coding during a CPE

[PMiklavcic]

When a patient comes in for an annual physical, is it appropriate to code the labs as routine (V70.0) if the patient has a medical dx to support the test?? (ie. a TSH is done & the pt has hypothyroidism, do you code the 244.0-244.9 or can you code the V70.0 b/c it is during the annual physical??)

We have been coding the medical dx to support the test & have been running into a lot of trouble b/c the patient calls & says they have routine coverage once a year for a physical & they call their ins co & the ins co's are telling them that the dr's ofc is billing it wrong b/c they have routine coverage.

If anyone can shed some light on this I would appreciate it greatly......this has been an immense source of frustration!!

Thank you.

 

[aarnold13]

The way that I understand this is that if the patient has a dx already that supports WHY they are getting the blood drawn then this is the code that needs to be used. Like you said, if someone has hypothyroidism already and they are having their TSH done to monitor this condition than it should be used. If they are just wanting yearly labs done like a general health panel just the check things over but have no underlying conditions than the V70.0 is appropriate to use here.

I have been running into the same thing with people that have a "wellness" section to their plan. They think we can just change the dx and all is fine. Just tell them that you don't look good in an orange jump suit! I did a lot of digging on this too, especially for people that are diabetic. I double checked with our billing office and they verified this.

 

[PMiklavcic]

Thank you so much!!