Awareness : Did You Know? 2015-2016

Did You Know? Weekly Educational Series 2

For the Week of August 24, 2015-Laboratory

Question: Can a lab be paid for ICD-9 diagnosis code V70.0 (routine general medical examination at a healthcare facility)?

Answer: This diagnosis code is for the routine evaluation and management of a patient, not for testing related to existing diseases or other conditions that require additional follow-up. Physicians are reimbursed when billing this code but clinical labs are not because it is statutorily non-covered and will be denied by Medicare.

However, If, during the course of the scheduled visit for a routine exam, a condition is identified and lab testing is ordered to determine a definitive diagnosis, the physician must update the encounter form with the appropriate sign or symptom that prompted the order for the test or tests. Assuming this code is added, the lab should be paid. Whether or not this occurs, of course, depends on the sophistication of the physician electronic medical record (EMR) system.

(Note: On October 1, 2015, ICD-9 diagnosis code V70.0 will change to Z00.00—general adult medical examination without abnormal findings.)