Wiki Lab Screening

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KLRuhe

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If a patient presents for their preventive exam and the lab order comes to the coding department with a diagnosis of "screening," would the correct code be V72.62 or can we code the V77.-- series based on the labs that are being ordered? Some payers don't pay for V72.62, but I'm wondering if we don't first have to read the physician's record to determine if they are screeing for a particular condition. Or am I being too conservative?

Kay, CPC
 
Wellness labs

I use V72.62. I have had some issues with ins companies not recognizing the code because it is new, but if the patient is in for a wellness exam, and the labs are ordered as part of that wellness, the labs should be coded to V72.62.
 
I would prefer to have a more specific screening dx myself if possible. Even for preventative visits, screening can be for many different dx's, such as pregnancy, STD, cancer, lipids, etc. You may run into problems with the generic screening codes, especially with certain payers. Some payers cover certain screening tests so the dx is pretty important I would think. JMO
 
Thanks. But to get that more specific diagnosis on your claim, must you read the physician's record to understand his intent? Or can we make the leap to the specific screening diagnosis just by deducing based on the tests ordered? For example, is it safe to assume that V77.0 (Special screening for thyroid disorders) would be the screening code to use for a TSH if the doctor writes "screening" as his diagnosis? Or, if we don't know his intent, should we be using V72.62 after a preventive exam? Thanks again...

Kay, CPC
 
Ouch, that is a good one. I think that I would leave that as a personal preference. I myself would not do that. I do not ever presume when it comes to dx's as it is my butt on the line in the end, so if I am uncomfortable and have questions about a dx, then I ask and hold the account. If there are office notes for a recent DOS and this is where the lab orders were ordered, then I would use a dx from those notes. We have a rule of thumb here at the very small hospital where I work that we use the code that is put in during the registration of the patient, and if anything failes pre-bill audits, then we email the clinic, or doc, to get a proper dx to cover the test if one is available. I don't necessarily agree with that method. However, many people may feel differently about this situation so it can go a lot of different ways. I find a lot of the time, that the way we do things here where i work(because we are so small) may not always be the right way but I try to always go with what I have learned to be correct over the years, regardless of what certain supervisors here may think as far as what "might" pass and get paid by doing it a certain way. You can't code just to get paid. It's fraud, so just remember to always cover your butt, right? All of this probably doesn't help much. Sorry I couldn't have a more firm technique or answer to give you:(
 
No, it helps! I agree with the "cover your butt" theory also. I just wanted other opinions outside of our department and so your opion is helpful. We have differing opinions here and we try and be consistent if we can, but I may sometimes "over-think" some coding principles. But again, I like to be careful in case I ever have to explain myself to someone who might ask how I arrived at my code selection. Thanks.
 
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