I need to rant - I hate the answer... If your doctor had coded this differently

[Guest guest]

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia. Pt. also complained of a decreased urine stream and was found to have an enlarged prostrate without dominant mass. We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:272.2401.1V76.44600.01V58.69 The labs were applied to the patient’s deductible and the patient got a bill for his deductible amount. He called his insurer who told him that we didn’t code his labs right and if we had coded tem as screening labs they would have been paid at 100%. My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code? Can anyone point me to this standard I writing that I can give to my patient? Dr. Beth Sullivan, DO

[Guest guest]

Ohh.  I feel your pain:

 

According to CPT and ICD-9 coding standards, you must always code to the " highest level of specificity. "   Therefore, you cannot code V70.0 on a lab order if you have a current dx of hypertension, hyperlipidemia, etc.  You coded it correctly.  If the patient had ONLY done his annual wellness visit and nothing else (and didn't have pre-existing dx), you could've coded V70.0, but since he received a more thorough, comprehensive visit (which you might explain to the patient you could have done as 2 separate visits and might have required even further lab work), and that the labs were coded " according to Federal Insurance Guidelines. "   To ask you to code it differently is insurance fraud.  Usually when I tell patients that if we change the coding, it is asking us to commit fraud, well, they don't want us to do that (and the ones that do aren't worth keeping as patients!).

 

 

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia.  Pt. also complained of a decreased urine stream and was found to have  an enlarged prostrate without dominant mass.  We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:

272.2

401.1

V76.44

600.01

V58.69

 

The labs were applied to the patient’s deductible and the patient got a bill for his deductible  amount.  He called his insurer who told him that we didn’t code his labs  right and if we had coded tem as screening labs they would have been paid at 100%.  My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code?  Can anyone point me to this standard I writing that I can give to my patient?

 

Dr. Beth Sullivan, DO

 

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

[Guest guest]

Ohh.  I feel your pain:

 

According to CPT and ICD-9 coding standards, you must always code to the " highest level of specificity. "   Therefore, you cannot code V70.0 on a lab order if you have a current dx of hypertension, hyperlipidemia, etc.  You coded it correctly.  If the patient had ONLY done his annual wellness visit and nothing else (and didn't have pre-existing dx), you could've coded V70.0, but since he received a more thorough, comprehensive visit (which you might explain to the patient you could have done as 2 separate visits and might have required even further lab work), and that the labs were coded " according to Federal Insurance Guidelines. "   To ask you to code it differently is insurance fraud.  Usually when I tell patients that if we change the coding, it is asking us to commit fraud, well, they don't want us to do that (and the ones that do aren't worth keeping as patients!).

 

 

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia.  Pt. also complained of a decreased urine stream and was found to have  an enlarged prostrate without dominant mass.  We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:

272.2

401.1

V76.44

600.01

V58.69

 

The labs were applied to the patient’s deductible and the patient got a bill for his deductible  amount.  He called his insurer who told him that we didn’t code his labs  right and if we had coded tem as screening labs they would have been paid at 100%.  My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code?  Can anyone point me to this standard I writing that I can give to my patient?

 

Dr. Beth Sullivan, DO

 

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

[Guest guest]

Beth,It is just a crazy world:  careful to code diagnosis for some plans as they don't cover some preventive; careful to code V codes for those that do cover preventive at a higher rate than diagnosis codes (and all the stuff covered under health reform now).

I just acknowledge it is screwed up and offer to re-code if it seems reasonable and helps the patient.  (I like to think of it as a higher level (universal moral principals) than the " law and order " level, but could certainly understand others seeing it differently.  See Stages of Moral Development if interested.)

My sympathies to all of us for having to deal with this at all.SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617

PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia.  Pt. also complained of a decreased urine stream and was found to have  an enlarged prostrate without dominant mass.  We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:

272.2401.1V76.44600.01V58.69

 The labs were applied to the patient’s deductible and the patient got a bill for his deductible  amount.  He called his insurer who told him that we didn’t code his labs  right and if we had coded tem as screening labs they would have been paid at 100%.  My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code?  Can anyone point me to this standard I writing that I can give to my patient?

 Dr. Beth Sullivan, DO 

[Guest guest]

Beth,It is just a crazy world:  careful to code diagnosis for some plans as they don't cover some preventive; careful to code V codes for those that do cover preventive at a higher rate than diagnosis codes (and all the stuff covered under health reform now).

I just acknowledge it is screwed up and offer to re-code if it seems reasonable and helps the patient.  (I like to think of it as a higher level (universal moral principals) than the " law and order " level, but could certainly understand others seeing it differently.  See Stages of Moral Development if interested.)

My sympathies to all of us for having to deal with this at all.SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617

PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia.  Pt. also complained of a decreased urine stream and was found to have  an enlarged prostrate without dominant mass.  We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:

272.2401.1V76.44600.01V58.69

 The labs were applied to the patient’s deductible and the patient got a bill for his deductible  amount.  He called his insurer who told him that we didn’t code his labs  right and if we had coded tem as screening labs they would have been paid at 100%.  My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code?  Can anyone point me to this standard I writing that I can give to my patient?

 Dr. Beth Sullivan, DO 

[Guest guest]

Beth,It is just a crazy world:  careful to code diagnosis for some plans as they don't cover some preventive; careful to code V codes for those that do cover preventive at a higher rate than diagnosis codes (and all the stuff covered under health reform now).

I just acknowledge it is screwed up and offer to re-code if it seems reasonable and helps the patient.  (I like to think of it as a higher level (universal moral principals) than the " law and order " level, but could certainly understand others seeing it differently.  See Stages of Moral Development if interested.)

My sympathies to all of us for having to deal with this at all.SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617

PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

Received a call from a patient who was seen in January for his annual wellness exam and while he was here for all that we also did the follow-up on his previously diagnosed hypertension and hyperlipidemia.  Pt. also complained of a decreased urine stream and was found to have  an enlarged prostrate without dominant mass.  We ordered a chem 7, lipid panel, lft’s and Vitamin D level (had previous low level on screen) We coded the lab order as follows:

272.2401.1V76.44600.01V58.69

 The labs were applied to the patient’s deductible and the patient got a bill for his deductible  amount.  He called his insurer who told him that we didn’t code his labs  right and if we had coded tem as screening labs they would have been paid at 100%.  My understanding is that if a patient was previously diagnosed with a condition that is covered by a screening lab, then a screening lab is no longer applicable ad the lab order is coded with the appropriate diagnosis code?  Can anyone point me to this standard I writing that I can give to my patient?

 Dr. Beth Sullivan, DO