Clarification of screening versus diagnostic blood test

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?

re: Clarification of screening versus diagnostic blood test

I would check your ICD guidelines,. Section 18-5

re: Clarification of screening versus diagnostic blood test

Screening by definition is the absence of signs and/or symptoms, so if a patient carries a diagnosis for which labs are done to monitor the status or efficacy of meds, it is NOT screening. It's hard for patients to understand this, but it is correct coding.

As for the glucose, it may have been ordered as screening, but the result now warrants the A1c, so the elevated level is the dx for the A1c. The dx for the glucose can remain screening.

re: Clarification of screening versus diagnostic blood test

Hi, I have been researching this issue. Do you have any references that I can check that state if the patient has a condition for which they are being treated that that is the diagnosis that should be used and not the V70.0? We have patients that always want it changed to V70.0 after they find out that their insurance will pay more. I know that over the past 15 years that I have read something to the effect of "screening is for the abscence of signs/symptoms or condition" and if the patient has the condition that is to be used. Any help would be appreciated.
Thank you.

re: Clarification of screening versus diagnostic blood test

ICD-9 guidelines, in the front of the ICD-9 book, look at the official guidelines!!!!