Why Does Insurance Deny V70.5?

The code V70.5 is a diagnostic code used in medical billing to identify procedures performed during a visit to the doctor. Insurance companies agree to pay or deny payment based on the codes submitted after the doctor treats you. The denial of a V70.5 is done for a few reasons.

Definition

• A V70.5 code is designated as "health examination of defined subpopulations." This code is given to physical examinations performed as pre-employment screening, for military personnel and truck drivers, among others. Only routine components of a physical exam are covered, with the exception being screenings tailored to a particular profession. The routine components include heart rate, blood pressure, vision, hearing and reflex checks. Urinalysis for drug screening may be a part of the exam as well.

Partial Denial

• Certain costs designated as V70.5 after a visit may be denied if they are deemed outside the scope of a health exam for a particular group. For example, a biopsy added to a trucker's physical exam will be denied as a V70.5 expense. The insurance company will pay all other procedures performed as usual.

Complete Claim Denial

• Sometimes, the inclusion of additional procedures can cause the entire claim to be denied by the insurance carrier. One reason is that by including certain procedures, the visit is transformed from a physical examination to something different. Adding a pap smear, for example, will transform the exam into a gynecological examination. Another reason is for failing to properly code the procedures during a visit.