Wiki Request screening test with known diagnosis-What stance do you take?

[AR2728]

This has been an issue for many years, but now thanks to Healthcare regulations, we are seeing this more and more. I would like to know what other offices are doing.

Patients are presenting requesting a preventive appt with screening laboratory tests, their insurance covers lipid, HGBA1C, etc, once a year at 100%. The problem, the patient is a known diabetic, with hyperlipidemia. These tests are no longer screening for conditions as he has a known condition-clearly documented throughout the years. We have, in the past, informed patients that these tests can not be billed as screening, due to the known condition.
What is your office doing in these instances? Would it be appropriate to use a screening diagnosis or v70.- code even if they have a known condition? Is it fraudulent to leave off their known condition when billing related laboratory tests?

 

[mitchellde]

You are correct these cannot be screening, if these tests are being performed because the patient is taking medication that needs to be checked then use the V58.83 and the V58.6x code for the test. You cannot indicate a reason for a test that clearly does not exist.. you cannot be screening for diabetes if the patient has diabetes and so on.. fraud? probably but certainly misrepresentation of the circumstances and cannot be supported by the medical record. Don't do it!

 

[AR2728]

I appreciate the reply. This has been our stance from both a billing and laboratory standpoint. Getting our physicians on board has been a bit more difficult, and of course, the patients speak directly to the physicians who inform them it will be taken care of. I just need some advice and opinions from others as I forsee this becoming more of an issue.

 

[Kim M Gordon]

to order a screening test really needs a V code stating you are screening for that particular disease, if they have been dx with it, are on medication for it, it is no longer a screening and insurance companies will deny a screening lab with a definitive dx...the same as if you order a diagnostic lab or xray with a screening dx....hope this helps.