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There is a lot of buzz in the healthcare industry recently about social determinants of health (SDOH) and their impact on society at large. With the expansion and updates to ICD-10-CM and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the new approach is to medicalize social problems. National claims data shows us that […]
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It is my understanding that when selecting the crohn’s or colitis with complication codes, the complication must be documented as being current/active.
For example, patient has a diagnosis of large and small bowel crohn’s. Several years back patient had a fistula that complicated his crohn’s disease; however, the fistula since been resected and the patient has been treated now for a couple of years with Remicade with no current/active complications of his crohn’s disease. Patient has had several follow up visits with no GI complaints and is doing well on treatment.
Question is, would the patient’s diagnosis for all current visits that are documented with no GI complaints and doing well on treatment still be considered crohn’s disease with complication?
If anyone can point me to any supporting documentation, that would also be very helpful.
We have been submitting wellness labs with Z00.00 and being paid by most of the private payers. I was later told that we can’t use Z00.00 for wellness labs because it’s improper coding and we will get killed later during payer audits for refund requests. I’m told we need to use the screening code specific to that lab. Now I’m being denied all the wellness labs and to top it off the payers will apply the cost to the patients deductible under 80050, and per the CLIA waived regulations we can’t bill 80050 because CBC does not fall under the CLIA waived category.
Instead of 80050 we use 80053, 80061, 84443 and 85025. The EOB comes corrected with 80050 and denials for the individual services as bundled. The doctor is adamant that we bill for all the codes.
I’m not certain which way to go. Can anyone tell me what diagnosis you use that works? I’m sure I sound like a crazy person but I’m trying to keep the doctor happy and making money rather than just tell her we have to have the lab bill for it.
Any help would be great.