Wiki routine lab dx

[kabishop]

We are having issues with routine exams. When a patient comes in for a yearly exam and has "routine" bloodwork, we are coding dx of v70.0, unless the patient has a history of related illness.
for example:if a patient has high cholesterol and has a "routine" lipid panel, we don't use the v70.0 because this is not a screening-as the patient has the dx. we use the v70.0 on the visit and other labs. We have patients that insist that the insurance is telling tham we should be coding the v70.0 even if that illness is already documented in their history. please advise as we are not going to code it just to please the patient, but we want to code it correctly.

 

[csehlmeyer]

Routine Labs vs Diagnostic Lab based on history

If the patient is having their annual preventive physical and their insurance will cover their routine labs such as lipids panel then code the labs with the V70.0, not the 272.X just because they have a personal history of lipids issues. It's not a matter of pleasing the patient; their insurance covers routine labs and at the time of their annual preventive physical, those labs are being ordered as part of their routine annual preventive benefit. It doesn't matter that they have a history of lipids, they also have routine covered services that their insurance will cover. This shouldn't be an issue. The reason for the occasion for the visit was routine, not diagnostic.

 

[mitchellde]

If you are checking labs during a routine visit for an already diagnosed issue that the patient is on medication for then the reason for the lab or other diagnostic is not the condition as you already know that, the reason for the lab as a routine is to check and make sure the medications are being effective in the treatment, therefore the appropriate code for the studies that fall in this area would be V58.83 and a V58.6x code. I have never had an issue with a payer covering the tests with these codes.