Wiki Coding chronic conditions with preventive well-checks

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pedscoder21

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What are the 'rules' on coding chronic conditions with preventive well-checks (99381-99395)?

For instance -

1) If an autistic patient presents for his annual well-check and the provider only references the autism in the neurological exam, would you or would you not code the autism with the V20.2/V70.0? As a side note, these conditions are always listed in the patient's "problem list" in our EHR.

2) If a patient presents for a well-check and has diabetes which is noted to be stable in the assessment, would you code it?

I would greatly appreciate any guidance on this topic and/or references!

Thank you :)
 
The ICD-10 CM code categories for the general preventive state "without complaint, suspected , or reported diagnosis". So no I would not code any of the chronic conditions as I consider those to be the other rooted diagnosis. And if the patient presents with a complaint the you cannot perform the wellness on the same day.
 
mitchellde said:
The ICD-10 CM code categories for the general preventive state "without complaint, suspected , or reported diagnosis". So no I would not code any of the chronic conditions as I consider those to be the other rooted diagnosis. And if the patient presents with a complaint the you cannot perform the wellness on the same day.
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Hi Debra,

Thanks for your quick response!

When you say "if the patient presents with a complaint then you cannot perform the wellness on the same day", could you clarify?

What if the patient presents for a wellness and the physician completes the wellness exam as well as addresses a patient complaint of frequent headaches? Then we can still bill the wellness with an e/m, correct? (provided that all e/m guidelines are met).
 
Read your ICD-10 CM code book the Z00.0 and the Z01 categories have an exclude 1 note that states exclude 1 encounter for signs and symptoms- code to the signs and symptoms. So as of Thursday you cannot code a well visit and a symptomatic complaint on the same encounter.
 
mitchellde said:
Read your ICD-10 CM code book the Z00.0 and the Z01 categories have an exclude 1 note that states exclude 1 encounter for signs and symptoms- code to the signs and symptoms. So as of Thursday you cannot code a well visit and a symptomatic complaint on the same encounter.
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Hi Debra,

Thank you, I did read that. I guess I'm still confused :confused: what would you do for the example I gave with the headaches? Is it still ok to code an E/M with a wellness as long as the additional symptomatic complaint is attached to the E/M? So, it would look like this with the diagnoses:

99395 - Z00.00
99213 - R51

I see that "abnormal findings" are classified to categories R70-R94, so that's why I am assuming that I would attach Z00.00 to the 99395 and NOT Z00.01.

Thanks so much for your input.
 
No t his is an exclude 1 note you cannot code symptoms with the well visit. It is a field 21 edit on the claim.abnormal findings are not expressed symptomatic complaints. It is an abnormal finding if the provider discovers an issue with a well patient with no presenting complaints.
 
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According to the guidelines and examples in the ICD10 book, it's acceptable to list other diagnosis codes. Under Chapter 21, section 13 it states that you don't use the Z codes if the exam is for diagnosis of a suspected condition. In such cases the diagnosis code is used.
Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and note focused on any particular condition.
 
cubbiecatz said:
According to the guidelines and examples in the ICD10 book, it's acceptable to list other diagnosis codes. Under Chapter 21, section 13 it states that you don't use the Z codes if the exam is for diagnosis of a suspected condition. In such cases the diagnosis code is used.
Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and note focused on any particular condition.
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The category however states without complaint, suspected, or reported diagnosis. So I am not sure if you are saying to add the symptoms or not but the exclude 1 note states that you cannot code signs and symptoms with the Z00 or Z01 codes.
 
cubbiecatz said:
According to the guidelines and examples in the ICD10 book, it's acceptable to list other diagnosis codes. Under Chapter 21, section 13 it states that you don't use the Z codes if the exam is for diagnosis of a suspected condition. In such cases the diagnosis code is used.
Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and note focused on any particular condition.
Click to expand...

Thanks for your input! That was my thought as well - I'm reading it now and it states, "the Z codes allow for the description of encounters for routine examinations, such as, a general check-up, or, examinations for administrative purposes, such as, a pre-employment physical. The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code."

Although, like Debra said, the Z00- series states, "encounter for general examination without complaint, suspected or reported diagnosis." - So, this is causing confusion...
 
The Z00 codes allow for abnormal findings with the code choice for with abnormal findings. That is not the same as a patient that presents with symptoms. And as you stated if the patient presents with a problem you cannot use the Z00 codes.
From your post:
The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code."
 
Pediatricians are asking me about the distinction between the two main ICD-10 codes for well visits/physicals. Apparently, one reflects a check up with problems discovered and the other without problems discovered. Do you have a feel for the significance of the difference re:
? Reimbursement rate
? Other issues?
Thank you,
Patricia
 
mitchellde said:
The Z00 codes allow for abnormal findings with the code choice for with abnormal findings. That is not the same as a patient that presents with symptoms. And as you stated if the patient presents with a problem you cannot use the Z00 codes.
From your post:
The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code."
Click to expand...

I work for a pediatric practice and quite often our physicians will see children for a well-check and discover a minor issue, such as cerumen impaction. The documentation of the impacted cerumen in the routine well-check exam and listing of the impacted cerumen diagnosis in the A/P does not warrant an additional e/m. They have been coding situations like these as V20.2, 380.4.

Yes, I stated, "the codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes." The exam is not for examination of a suspected condition. The encounter was for a routine well-check, not for a complaint, and upon the routine exam a condition was found. So, I feel that now I've read the guideline that states, "during a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code," you can code a diagnosis/condition as a secondary diagnosis to the Z code when the initial purpose of the exam was for a routine health check.
 
Debra, I am saying add the codes, since that is what the ICD10 guidelines state to do. Based on the guidelines I interpret the exclude note to coincide with the first example, meaning if a patient came in for a suspected condition, but it came back normal the doctor cannot code this visit with a Z code and report it as a general or normal exam. The doctor has to code it is a problem visit with the signs and symptoms.
 
I submitted my question to the AAP this morning and they responded with some very helpful documents with examples (obviously, they are related to pediatrics). These examples include coding the pediatric Z codes with diagnoses found upon examination. If anyone would like a copy of them, please post your email and I will forward ;)
 
pedscoder21 said:
Thanks for your input! That was my thought as well - I'm reading it now and it states, "the Z codes allow for the description of encounters for routine examinations, such as, a general check-up, or, examinations for administrative purposes, such as, a pre-employment physical. The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code."

Although, like Debra said, the Z00- series states, "encounter for general examination without complaint, suspected or reported diagnosis." - So, this is causing confusion...
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Persons encountering health services for examinations (Z00-Z13)

Z00.0 - Encounter for general adult medical examination

Z00.00 - Encounter for general adult examination - without abnormal findings.

Z00.01 - Encounter for general adult examination - with abnormal findings. (Why cannot this code explain an E/M for a problematic diagnosis at the same time as the physicial?)
 
Love Coding! said:
Persons encountering health services for examinations (Z00-Z13)

Z00.0 - Encounter for general adult medical examination

Z00.00 - Encounter for general adult examination - without abnormal findings.

Z00.01 - Encounter for general adult examination - with abnormal findings. (Why cannot this code explain an E/M for a problematic diagnosis at the same time as the physicial?)
Click to expand...

Because the exclude 1 notes that an encounter for signs and symptoms are excluded and cannot be coded, you are instructed to code to the signs and symptoms, an abnormal finding is something not exhibited or suspected, it is discovered by the provider in the course of examining an otherwise a symptomatic patient
 
pedscoder21 said:
I submitted my question to the AAP this morning and they responded with some very helpful documents with examples (obviously, they are related to pediatrics). These examples include coding the pediatric Z codes with diagnoses found upon examination. If anyone would like a copy of them, please post your email and I will forward ;)
Click to expand...

I would like this very much please. :)

dshoemaker
dscoder74@yahoo.com
 
mitchellde said:
Because the exclude 1 notes that an encounter for signs and symptoms are excluded and cannot be coded, you are instructed to code to the signs and symptoms, an abnormal finding is something not exhibited or suspected, it is discovered by the provider in the course of examining an otherwise a symptomatic patient
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Does this also apply to the Peds codes? Z00.110-Z00.129??? As I do not see the Excludes 1 in this area...thank you :)
 
Same confusion

I am running into the problem for OB/GYN. When we do an annual and we note that the patient has prolapse or something but we are not doing anything about it at this visit would we code the abnormal findings along with the z code for annual.
Also if they have abnormal PAP since that is not seen at the visit would that be coded to no abnormalities found because we don't know it is abnormal till two weeks later and we would code the abnormal at the next visit. We typically have our charges out 2 days after the visit.
Super coder in 2011 said the abnormal pap had nothing to do with the z code chosen. HELP Please. :eek::confused:
 
mitchellde said:
While the exclude one note is at the Z00.0 sub category the category heading for all Z00 codes states without complain, suspected, or reported diagnosis
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I am not seeing that stated in my category heading. It should be right under chapter 21, correct? This is very confusing. Why would the guidelines specifically state you can code chronic conditions with a wellness if that were not the case?
 
The guidelines don't state that specifically. Look at the Z00 category , the category description is part of each individual code descriptions, then right under the Z00.0 subcategory and the Z01 category you will see the exclude 1 note.
 
Love Coding! said:
Does this also apply to the Peds codes? Z00.110-Z00.129??? As I do not see the Excludes 1 in this area...thank you :)
Click to expand...

I asked AAP and according to their response, "It applies to the Z00-0- and the Z00-12- codes do not fall under that Excludes note."

If you look in the book, the excludes note that Debra is referring to is only for the Z00.0- codes, it is not listed with the Z00.12- excludes notes.
 
Yes that is correct and I stated that but the category description goes for all Z00 codes and the category states without complaint.
 
The excludes note is just for encounter for exam of signs and symptoms....that shouldn't apply to chronic conditions.
 
Again I refer you to the category description that states without complaint, suspected or reported diagnosis. The chronic conditions would be the reported diagnosis
 
mitchellde said:
Again I refer you to the category description that states without complaint, suspected or reported diagnosis. The chronic conditions would be the reported diagnosis
Click to expand...

I completely understand what you're saying/looking at Debra. But, like Radcoder said, why do the coding guidelines state, "during a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition"

The book also states that "routine examinations" include Z00-

VERY conflicting definitions. :eek:
 
And that category description is what I'm not finding. I'm looking at the note under Chapter 21 and at the excludes notes under the Z00 category, and I don't see that "without complaint, suspected or reported diagnosis" mentioned. Can it be a difference in books? I have an Optum book.
 
Aapc exam result

Hi, I did my COC exam on past 09/19/2015 still I haven't received result & some of them got a result who did exam on a same date of 09/19/15. But My result is still showing "received" only. So can anyone clarify me??
 
Look at the category Z00 it should be in every book. The category is the key part to every code. Some books I hav looked at on this one the Z00 is on a previous page from the rest of the category.
 
Oh gosh, ya I see it now....I feel dumb. I think it's pretty grey though. I interpret that as a complaint or suspected or reported diagnosis from the patient. It's probably best to play it safe though and not code anything with it. Thank you for your help....and patience. :eek:
 
That is a general statement for administrative Z codes, any one Z Catergory or code can over ride a general statement. It was not a statement specific to the general wellness codes.
"during a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition
Ok the first sentence is consistent with abnormal findings, something that is discovered when examining an asymptomatic payient.
The second statement state they may be added as long as the visit is not focused on any one. Which is fine except the category states without reported diagnosis, the preexisting conditions are the rooted diagnosis. So any one code description will over ride a general guideline
 
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Are immunizations going to be able to be administered at wellness visits if it's for preventative?
 
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Okay, I think this is my last question, what about wellness labs? Sometimes they aren't drawn until the patient comes in for their wellness and there are some tests now that are routinely drawn with wellness that aren't covered under the wellness diagnosis. Are we not going to be able to use any other codes for the labs since the exam and labs would all be on the same claim?
 
Are they screening, or due to medications the patient is receiving for chronic illness? If so use the the screening Z codes, and/or the Z51.81 with the Z79 codes for the drug monitoring.
 
The screening codes are only permitted if we aren't sure whether they have a disorder, correct? So thyroid for instance, if we know they have hypothyroidism and they are on medication, we'd have to use a Z51 & Z79 to run that test with a wellness exam?
 
I spoke with my supervisor regarding this and she called Optum and they are saying we're still allowed to bill an office visit with PE's in ICD 10?:confused:
 
So am I completely misunderstanding this whole post? I was under the impression that nothing else can be billed along with a physical unless abnormal findings are found in the exam. So if a patient presents for their physical, but is also complaining of a cough, we would have to code to the signs and symptoms and code a regular office visit for treating the cough, and we would not be able to able to charge for a physical.
 
Radcoder86 said:
So am I completely misunderstanding this whole post? I was under the impression that nothing else can be billed along with a physical unless abnormal findings are found in the exam. So if a patient presents for their physical, but is also complaining of a cough, we would have to code to the signs and symptoms and code a regular office visit for treating the cough, and we would not be able to able to charge for a physical.
Click to expand...

My original question was regarding ICD codes and when it is appropriate to code chronic conditions or additional diagnoses with well checks.

The debate has been whether or not you can code a well check code (Z00-) with a diagnosis code (and attach both to the well visit 99395). The ICD 10 book states an excludes 1 note under Z00- saying, "encounter for examination of sign or symptom- code to sign or symptom." An adult or child that presents to his/her primary care physician for a well-check is not presenting for an encounter for examination of sign or symptom. If the patient happens to bring up a complaint during the exam, then this complaint should be treated as an additional e/m with the well visit.

Of course, not all physicians will document enough to warrant an e/m. The coding guidelines state that chronic conditions or additional diagnoses found upon examination of a patient during a routine health exam can be coded as secondary diagnoses.

Chapter 21 of the ICD 10 book states that nonspecific abnormal findings are coded using R70-R94. The Z00- codes do not use the term "nonspecific" (such as Z00.01 encounter for general adult medical examination with abnormal findings), so, any other abnormal findings such as a specific diagnosis like headache can be coded in addition to the Z00.01 code.

Of course, this is my interpretation of the rules and I realize not everyone agrees. I appreciate all of the feedback and would love to hear more!!!!! I wish this was more clear. :)

I've been re-reading the ICD-10 book over this for the past couple of days, along with the other coders in my office...this has been quite confusing!

I work in pediatrics, so I submitted my concern to the AAP and they provided me documents stating that yes, you can code chronic conditions and diangoses found upon examination of the patient in addition to the well check Z00.121.
 
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