Wiki Preventive Service vs Medical Diagnosis

[Lindsey_McBee]

I have several docs that will do a CPE with V70.0 and then list all the labs under the same diagnosis. They will often list a medical diagnosis secondary to the V70.0 (such as 272.4 for a lipid panel or 244.x for TSH or something). Since the patient is currently under the care of the physician for the medical condition would it be appropriate to code V70.0 or should I use the code that best describes the medical condition? This causes a lot of problems at my office because physicians defend the V code because the tests are done with the physical. What should I do????

 

[KATE1214]

Kate

There is always alot of debate about this subject and it is not so much a coding discussion as a billing one. I personally use the V code when I have the basic labs, CMP TSH Lipids. The reason being that some insurance companies will pay at 100% as part of the preventative some basic labs as well as the physical itself and they will base their payment on how we code them. I know for the plan that I am in, I MUST have my labs coded with the V code to have them paid 100%. Our benefit pays for one such group of labs per year as part of our preventative benefits. There is nothing wrong with using a dx as a secondary code should you wish to. I tend to use it if the labs are beyond what some companies might consider a necessary preventative lab. It gives me backup just in case. That would be for labs like the CRP or any testing for diabetes/glucose levels, things of that nature.

Hope this helps.

 

[akandrew]

If you look at the ICD-9 outpatient guidelines, you will find a section (L.)Patients receiving diagnostic services only. There is a statement: If routine testing is performed during the same encounter as a test to evaluate a sign, symptom or diagnosis, it is appropriate to assign both the V code and the code describing the reason for the non-routine test.

I hope this helps.