|A patient of ours came in for a routine physical and blood work. This pt is on meds for high blood pressure and cholesterol. He came ahead of the DOS and did the blood draw. The doc coded the blood test order with the ICD9 condition codes (401.1/272.4), since the pt has these conditions. The pt's insurance will only cover the tests as "screening or routine" and so pt is complaining and wanting doc to change codes to avoid having to pay. They feel that they were in for a routine physical and that is what the bloodwork should be considered. My question is since the pt already has these conditions and is on medication for them, what is the right way to code this?
Also, when the lab tests came back prior to the PE, his blood sugar was elevated and so doc wanted an A1C lab test. My interpretation of the ICD9 guidlelines is that this would also not be considered "screening/routine" since it was done to rule out or confirm a suspected diagnosis. Is this right?