Basically, if you already have a condition (even if it's being treated and is controlled), or if you have symptoms, then lab work ordered is not preventive. The Affordable Care Act of 2009 requires that most insurance companies pay 100% for Preventive Care.
For screening tests, the appropriate ICD-9-CM screening code from categories V28 or V73-V82 (or comparable narrative) should be used. (From Coding Clinic for ICD-9-CM, Fourth Quarter 1996, pages 50 and 52). When a non-specific ICD-9 code is submitted, the underlying sign, symptom, or condition must be related to the indications for the test.
The labs for monitoring of the drugs the patient is taking for there chronic conditions are best coded with the V58.83 for therapeutic drug monitoring and V58.6x to indicate the drug. You are not alone. This is a problem everywhere.
”The code is V81.2. TIP: Always document (link) signs, symptoms, and the diagnostic gets paid. 2 TIP: Try searching for “exposed disease. signs, symptoms, abnormal test results, exposure to communicable disease or other reasons for the visit.
From ICD-10: For encounters for routine laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign Z01. 89, Encounter for other specified special examinations.
121, Z00. 129, Z00. 00, Z00. 01 “Prophylactic” diagnosis codes are considered Preventive.
ICD-10-CM Code for Encounter for blood typing Z01. 83.
2013 ICD-9-CM Diagnosis Code 790.99 : Other nonspecific findings on examination of blood.
Preventive plans include various tests such as a blood test for sugar and cholesterol, pressure monitoring, cancer screening, Pap smear, HIV and genetic testing.
Essentially, the goal of preventive care is to detect health problems before symptoms develop, while diagnostic care is given to diagnose or treat symptoms you already have. Preventive care is frequently received during a routine physical. Diagnostic care may result if a preventive screening detects abnormal results.
Encounter for screening for other metabolic disorders Z13. 228 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z13. 228 became effective on October 1, 2021.
Test Abbreviations and AcronymsA1AAlpha-1 AntitrypsinCBCComplete Blood CountCBCDComplete Blood Count with DifferentialCEACarcinoembryonic AntigenCH50Complement Immunoassay, Total204 more rows
NCD 190.15 In some patients presenting with certain signs, symptoms or diseases, a single CBC may be appropriate.
220.
Short description: DMII wo cmp uncntrld. ICD-9-CM 250.02 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 250.02 should only be used for claims with a date of service on or before September 30, 2015.
If the patient does not have the diagnosis and is not being treated for the chronic condition, then it is screening and that is the appropriate coding. However the patients do have the ability to refuse any testing if they are made aware before hand that they will be responsible for the bill. if they are not informed of the nature of the testing, and it is discovered that the screening is not covered, then you will have difficulty collecting the payment from the patient.
There are many carriers that will not accept the Z00.00 for labs. If it is truly screening then the screening Z code is correct. If the patient has a chronic condition and is on medication that requires monitoring then use drug monitoring. Not all screenings are covered services. You need to advise the patient to check their preventive benefits ...