Diagnosis codes for labs please
579.9 Unspecified intestial malabsorption: should cover all postop labs since it is the cause of most other postop conditions such as electrolyte abnormalities, anemias, vitamin/mineral deficiencies, malaise/fatigue, etc.
I'd avoid surgical malabsorption (579.3) since that may be considered pre-existing or require further paperwork before insurance will pay. The more generic the better for insurance purposes.
I wouldn't use these others listed:
790.6 is other unspecified lab abnormalities: a generic code.
279.9 is unspecified disorder of immune mechanism.
402.90 is unspecified cardiac disorder without heart failure.
Hope this helps.
I'd avoid surgical malabsorption (579.3) since that may be considered pre-existing or require further paperwork before insurance will pay. The more generic the better for insurance purposes.
I wouldn't use these others listed:
790.6 is other unspecified lab abnormalities: a generic code.
279.9 is unspecified disorder of immune mechanism.
402.90 is unspecified cardiac disorder without heart failure.
Hope this helps.
Thank you Steve! The only way I can get labs is to write my own lab slip so I have a bit of a struggle. On top of that, I moved, so now I am having to try to get a new doc to sign my lab slip and hope I don't get "have your surgeon order your labs" because my surgeon won't order complete labs and won't allow me to chose what lab I prefer to use (not Labcorp).
So I truly appreciate the help!
~Becky
So I truly appreciate the help!
~Becky
But if your insurance did not pay for your surgery or now excludes it, do not use those 579 codes. Kiss of death for labs.
I separate them on my sheet because they don't even apply to bands and sleeves, but also, for those of us in this state who work for small companies and cannot buy WLS coverage (I need 42 more employees!), many of the others are perfectly legal and accurate, without kicking in the 579's.
I separate them on my sheet because they don't even apply to bands and sleeves, but also, for those of us in this state who work for small companies and cannot buy WLS coverage (I need 42 more employees!), many of the others are perfectly legal and accurate, without kicking in the 579's.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Ok.
Mine excludes any weight loss program of any kind and any complication or anything to do with it. What was once a one sentence exclusion is now 2 paragrahps. AND I've had to eat 1 yrs worth of labs for both of us, so 3 months each? 8 sets of labs.
We learned to use any valid codes except those. Intestinal malabsorption can be any other thing, but SURGICAL would drop that whole bill in my lap.
Sometimes I wonder about my insurance. I got an "incident report" yesterday. I called and asked them what incident I had? It was an MRI as a diagnostic tool for rheumatoid. I said so, but finally realized that the rep I had had no idea what that meant. She wanted date of onset. ??? The day I was born? The day became more than I can manage? She kept trying to pick a start date, and describe the "incident". Finally, the light downed on me and when I had to spell both rheumatoid and arthritis, I knew she did not get it and the incident would still be reported as an "incident", but with no 3rd party (like a car accident or dog bite). Whew, scary.
So for me, even "intestinal malabsorption", which could be Crohn's or Celiac, could result in denial.
Mine excludes any weight loss program of any kind and any complication or anything to do with it. What was once a one sentence exclusion is now 2 paragrahps. AND I've had to eat 1 yrs worth of labs for both of us, so 3 months each? 8 sets of labs.
We learned to use any valid codes except those. Intestinal malabsorption can be any other thing, but SURGICAL would drop that whole bill in my lap.
Sometimes I wonder about my insurance. I got an "incident report" yesterday. I called and asked them what incident I had? It was an MRI as a diagnostic tool for rheumatoid. I said so, but finally realized that the rep I had had no idea what that meant. She wanted date of onset. ??? The day I was born? The day became more than I can manage? She kept trying to pick a start date, and describe the "incident". Finally, the light downed on me and when I had to spell both rheumatoid and arthritis, I knew she did not get it and the incident would still be reported as an "incident", but with no 3rd party (like a car accident or dog bite). Whew, scary.
So for me, even "intestinal malabsorption", which could be Crohn's or Celiac, could result in denial.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
This is a great question, Michelle. I just got a new insurance and they don't cover weightloss anything or anything caused by weight loss surgery. Lifewise of WA
I don't know what code to have my doc use to get these paid. I would rather this insurance not even know i had surgery, they might start getting denial crazy. My last insurance company wouldn't pay for any of my labs. It got really pricey. What codes do you suggest?
I don't know what code to have my doc use to get these paid. I would rather this insurance not even know i had surgery, they might start getting denial crazy. My last insurance company wouldn't pay for any of my labs. It got really pricey. What codes do you suggest?
HW - 395 / SW - 358 / GW - 150
any of the codes I list that are NOT 579.
If you know of any conditions, you use those. Like anemia, iron. Or if you've had trouble, anemia, other (or unspecified). If you KNOW you had low vit D, you can use that or the more generic "hypovitaminosis".
Since the entire country is in trouble with D, that's not an issue.
Thing is, don't lie. Use the ones you know are valid, but you don't have to use every code.
For example: osteoporosis covered a specific test I've been having for years. Along with the usual group, of course. My doc moved, so the new guy used a dx code: looking for bone matrix, blah, blah. Ah, well they don't pay for it then. They will pay for the same test for osteoporosis, but he got too specific and dumped a $200 back in my lap. Thanks. Had he used the code we've used for years, we both would've been ok. But asking for it to look at "collagen cross links for bone matrix..." shot it back. All collagen cross links are "experimental". Not covered. Even tho the test itself WAS covered under different dx code.
Step lightly. Do not lie, ever. Just use the ones you KNOW are valid. You only need 2-3, not all of them. If you HAD diabetes, that opens many doors. And so on.
If you know of any conditions, you use those. Like anemia, iron. Or if you've had trouble, anemia, other (or unspecified). If you KNOW you had low vit D, you can use that or the more generic "hypovitaminosis".
Since the entire country is in trouble with D, that's not an issue.
Thing is, don't lie. Use the ones you know are valid, but you don't have to use every code.
For example: osteoporosis covered a specific test I've been having for years. Along with the usual group, of course. My doc moved, so the new guy used a dx code: looking for bone matrix, blah, blah. Ah, well they don't pay for it then. They will pay for the same test for osteoporosis, but he got too specific and dumped a $200 back in my lap. Thanks. Had he used the code we've used for years, we both would've been ok. But asking for it to look at "collagen cross links for bone matrix..." shot it back. All collagen cross links are "experimental". Not covered. Even tho the test itself WAS covered under different dx code.
Step lightly. Do not lie, ever. Just use the ones you KNOW are valid. You only need 2-3, not all of them. If you HAD diabetes, that opens many doors. And so on.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
I vaguely think I've read instructions having to do with these lab codes that specifically instruct one to use the most specific code that applies (in other words, to use surgical malabsorption rather than the unspecified intestinal malabsorption that we'd rather use). Could it be considered insurance fraud to not be specific?
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