Coding > Coding

DX for blood tests

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RichardP:
Kerri - you are welcome.

Your comments seem to indicate that there is some butting of heads between you and the providers over how to code for these screenings.

Seems to me the simple solution would be to show the providers the EOBs that are returned showing that the CPT codes linked to the Z13.0 DX code get paid zero dollars.  If the dollars paid are actually something greater than zero, then that is the end of the issue.  But if those dollars paid actually are zero, a demur wouldn't you like to get paid for these screening tests? should trigger some sort of better response in the providers' minds.

Kerri:
sigh, that's part of the problem.  We submit the order, but the labs are done elsewhere. And when the insurance doesn't pay, the patient calls ME saying we coded it wrong. If I say we don't code it, Spectrum does, they say Spectrum said to call YOU.  So we are not billing it out, or getting paid for it. And the hospital doesn't care. I work in a very Liberal office and we go out of our way to help the patients.  I have been here 5 months and this is by far my biggest problem.

RichardP:
These are rhetorical questions.  I'm not expecting an answer, but they might help focus your attention.

1.  Does the lab accept blood for testing without any instructions re. what to test for?

2.  If the answer to #1 is No, (and it should be no), then they are coding based on the information provided by the doctor.  That would be why they say to call you.

3.  Whoever is drawing the blood to send to the lab has to be doing it at the direction of the provider.  What reason did s/he give the blood drawer for why they needed to draw blood and send it to the lab?  Again, the labs aren't going to accept blood for testing without knowing what they are testing for.  So - what the provider tells the drawer of blood would be the place to examine what is going on.  "What they are checking for" would be the CPT code your office must provide.  "Why they are checking for that thing" would be the DX code your office must provide.

The lab should not be making things up out of thin air.  They should be acting based on what your office tells them.  If this is not happening, (if the lab is not getting CPT and DX codes from your office) I would start looking for kickbacks from the lab to your office.  No instructions to the lab would be an indicator of fraud.  (e.g., here, run any test on this and give me part of the money you get for doing this.)

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