Lori Posted Mon 23rd of July, 2012 13:15:48 PM
We have a patient who did not have a urinalysis done at his previous well visit, but then needed it done for his camp form. The patient did not have any problems or issues with urination, just needed it for his camp form records. What diagnosis code could we use to submit this service to insurance? If we use the well child diagnosis code, the insurance may not pay for the actual well visit diagnosis code when the patient needs it. Please advise. Thank you.
SuperCoder Answered Wed 25th of July, 2012 15:49:41 PM
Unfortunately, I'm not sure you'll get paid by the insurance for this service. I don't think they will pay you for a urinalysis for a camp form.
I would suggest in this sort of situation, collecting from the patient upfront -- probably $3-#4 based on the Medicare fee schedule. (You can also have the patient sign an ABN-style waiver so you can bill him.) Then, you could submit the charges to the insurance company and reimburse the patient if they pay you. However, I don't think they will.
To bill the insurance, I would suggest 81000 with diagnosis code V72.60.
You may even decide that the $3 or so isn't worth the hassle of collecting/billing it out.
I hope this helps you some.
Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Lori Posted Thu 26th of July, 2012 18:47:31 PM
We thank you for getting back to me regarding his information. Could we ask two more questions?
1) Could diagnosis code
V70.3 be billed?
2) If we bill either diagnosis code,
V70.3, would this affect a patient's well visit? For example, if we bill the codes, get paid by the insurance , and then the patient needs a well exam, would this interfere with us getting paid for a well exam?
We appreciate your feedback and look forward to hearing from you soon!
SuperCoder Answered Wed 15th of August, 2012 18:59:53 PM
I think V70.3 would apply more to the exam for camp rather than the urinalysis. The code descriptor says "general medical examination" and I don't think urinalysis fits under that. I would suggest V72.60 is a more appropriate code for the urinalysis. If you are looking for a diagnosis code for the associated well exam (if that was done only for the camp forms), then I'd use V70.3 for that.
For question 2, I assume you are asking if you use V72.60 or V70.3 with the urinalysis (not with the well exam code), will that affect a future well exam. Again, I would only use V72.60 would apply to the urinalysis, so I don't see any reason it would affect a future well exam. If you are asking about billing the well exam code (not the urinalysis) with V70.3, that may potentially affect a future exam. I think it would depend on your contract and the actual payer. Unlike annual preventive medicine services, sports and camp physicals are usually noncovered services. Usually payers won't pay for a for-camp-only well exam, and you would bill the patient. I would expect the insurance won't cover the camp physical anyway, so you'd bill the patient, and then when he needs his regular well exam, you can bill the insurance for that visit.
I hope this helps.