AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Expert: Linda Woolsteen Date: 10/30/2007 Subject: Coding Liver Function Screening
Question What ICD9 code should be used to bill for Liver Function Screening for patients on high risk medication, i.e., Lipitor, Prednisone, etc.
Answer I cannot advise what code to use. But, I can tell you that the way we (as an Insurance Company) looked at claims when they came in was like this: Routine visits usually were billed with the V codes and diagnostic claims were not. If the person already, apparently has a medical condition that they need Lipitor, Prednisone, etc. then there must be a diagnosis.
Generally, when people had a routine benefit on their policy they would want things billed as routine. If they had already exhausted that benefit or did not have a Routine benefit, then they wanted it billed as just a diagnostic office visit so their copay would apply if they had one. We would advise that the provider is suppose to bill for what was done in the office that day, not according to get it paid by their policy. But... if they weren't happy they would have to appeal in writing and have the office notes for that visit submitted. If the office notes supported the code being billed then we would go with that and reprocess the claim if need be. So, if you are a patient asking... whatever you mention to your physician usually goes into your office notes and if they get requested then that information is there for the insurance company. For example, you go in for your routine pap test. You haven't had any female problems but while there you mention you have been feeling depressed a little. If the provider bills with a mental nervous code then it may be processed under your mental/nervous benefits which is usually subject to deductible/coinsurance. The provider could bill with the first diagnosis as a V routine/code then the mental/nervous as a secondary diagnosis. We, as an insurance company, generally would process the claim based upon the primary diagnosis. But, if the provider put the mental/nervous code first and the routine pap as secondary then of course it would fall under the mental/nervous benefit.
Routine codes generally mean there is no foreseen problem. Again, if already on the medication and it is just a check up I would assume it would be billed with a diagnosis code not a routine/V code.
