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Ann Posted Wed 10th of September, 2014 16:13:46 PM

I having an issue finding the appropriate diagnosis codes for a patients STD testing and pre conception FSH blood test. We provided the lab with V01.6 , 626.4 the test were allowed but applied to deductible. Patients states this is covered 100% under her preventative care and we did not provide appropriate codes, other than trying V74.5 I am at a loss.

SuperCoder Answered Thu 11th of September, 2014 08:50:48 AM

Thank you.

You must coded with the diagnosis the provider orders the test for. Patients have a variety of insurance and it is non-compliant to change a diagnosis solely for the purpose of getting a claim to be paid/covered. If the patient's insurance is allocating to the deductible and the patient's understanding is that this is preventive, he/she may need to appeal to the payer.
You can contact the payer to verify the patients benefits for this type of lab service as well. When calling the payer, provide the CPT code as well as the DX codes and they can educate on the patients plan.

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