Wiki "Wellness labs" and chronic conditions

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PaigeMatthews

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Pt is having "Wellness labs" performed - Hemoglobin A1C, TSH, CMP, CBC w/diff. -routine panel.
Provider originally sent over with hypertension, mixed hyperlipidemia and elevated fasting glucose DX but pt called and complained because it wasn't covered and wants it changed to Z00.00 provider told pt that was fine and is now arguing that we should be coding it with Z00.00 because not all labs are strictly for chronic conditions - some are for screening..
What would be the correct way to DX code these labs?
Any articles to back this up?
Thank you!
 
ivygirl18@hotmail.com said:
Does the patient have those conditions?
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Yes -- which is why I'm thinking it's not appropriate to use the Z00.00 but provider is now stating "not all labs are just to monitor their chronic conditions"
I feel wishy-washy about it since OK sure, but really, all of those labs could possibly give insight on the effects or causes of hypertension/etc. I believe.
 
If the insurance company audited this claim would the medical records support that each of the labs listed were ordered based on the preventive DX code Z00.00 requested by the patient.

If you just change the claim as requested by the patient and approved by the provider and the claim is audited by the carrier and the notes indicate the labs were ordered based on her various chronic conditions the carrier is likely to adjust the claim to either flat out deny because records don't support the claim as billed or they may just adjust the claim to apply her medical benefits instead of the wellness benefits.

This type of action is a red flag for insurance companies, and it could put your provider on the insurance company's radar as one to watch for inappropriate billing practices.

If the records don't support the change in DX you might want to discuss it with your provider and explain the potential negative impacts that making the change to this claim could cause.
 
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