We have an ongoing issue with Blue Cross when patients come in for their annual physical and have labs and other screening services done. I am curious if we are coding things the same as everyone else and what your results are. We are a rural health, critical access hospital and we have to bill our labs and imaging through the hospital.
From what we were told, according to Medicare guidelines, is that even if a patient is coming in for screening labs, if they have a history of hypertension or high cholesterol, for example, we have to list those codes also. We put the screening diagnosis as primary and the others listed underneath. BCBS has told us that they changed their system recently so that no matter what is listed primary, if there is a diagnostic code on the claim as well, they will go by that and the charges go to the patient's deductible.
Another example: we started promoting lung screenings and I had a patient who called BCBS before coming in to make sure that the service would be covered and was told that it would be as long as we coded it as screening. We put the screening diagnosis primary but they found nodules during the test so we listed the nodules secondary. BCBS put it to deductible and the patient is getting a bill for over $800.
This is very frustrating on everyone's part. The patients are trying to make sure they are getting their preventive services and are being told that they will be covered and paid at 100%. It makes us look like the bad guys even though we are following Medicare guidelines when coding. BCBS tells the patients that we are coding it incorrectly.
Does anyone have any information for me??
Thanks!
From what we were told, according to Medicare guidelines, is that even if a patient is coming in for screening labs, if they have a history of hypertension or high cholesterol, for example, we have to list those codes also. We put the screening diagnosis as primary and the others listed underneath. BCBS has told us that they changed their system recently so that no matter what is listed primary, if there is a diagnostic code on the claim as well, they will go by that and the charges go to the patient's deductible.
Another example: we started promoting lung screenings and I had a patient who called BCBS before coming in to make sure that the service would be covered and was told that it would be as long as we coded it as screening. We put the screening diagnosis primary but they found nodules during the test so we listed the nodules secondary. BCBS put it to deductible and the patient is getting a bill for over $800.
This is very frustrating on everyone's part. The patients are trying to make sure they are getting their preventive services and are being told that they will be covered and paid at 100%. It makes us look like the bad guys even though we are following Medicare guidelines when coding. BCBS tells the patients that we are coding it incorrectly.
Does anyone have any information for me??
Thanks!