Wiki Child wellness or adult annual preventative?

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mgarcia400

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Hello all,
I bill for a family practice. We had a new patient come in for their annual physical along with an immunization. Billed was Z00.00 (patient is 18yrs old) with 99385, also adult Z68.20 (adult BMI).

The claim was denied "invalid diagnoses code with patient's age and/or gender." Requested a corrected claim with appropriate procedure code for patient's age.

My question is, even though the patient is 18 years of age, does this still fall under a child wellness visit and should be coded as Z00.129 along with pediatric BMI code? I know some payors may be different with these rules. This was Cigna insurance.
Can someone please clarify?

Thank you!
 
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mgarcia400 said:
Hello all,
I bill for a family practice. We had a new patient come in for their annual physical along with an immunization. Billed was Z00.00 (patient is 18yrs old) with 99385, also adult Z68.20 (adult BMI).

The claim was denied "invalid diagnoses code with patient's age and/or gender." Requested a corrected claim with appropriate procedure code for patient's age.

My question is, even though the patient is 18 years of age, does this still fall under a child wellness visit and should be coded as Z00.129 along with pediatric BMI code? I know some payors may be different with these rules. This was Cigna insurance.
Can someone please clarify?

Thank you!
Click to expand...

It's the BMI code. Look in your ICD-10-CM book under the Z68 Body Mass Index heading and it explains the age ranges for those codes.

BMI adult codes are for ages 20 and up.

BMI pediatric codes are for ages 2-19.
 
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sls314 said:
It's the BMI code. Look in your ICD-10-CM book under the Z68 Body Mass Index heading and it explains the age ranges for those codes.

BMI adult codes are for ages 20 and up.

BMI pediatric codes are for ages 2-19.
Click to expand...
Is listing a pediatric BMI code going to conflict with Z00.00 since that's adult or should it be Z00.129 for child?
 
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mgarcia400 said:
Is listing a pediatric BMI code going to conflict with Z00.00 since that's adult or should it be Z00.129 for child?
Click to expand...

It shouldn't. The Z00.00 is appropriate because your patient is 18.

The BMI codes have different age ranges attached to them than the encounter codes. The patient is 18, so you'd use the BMI code that applies to ages 2-19.

Try not to get hung up on the peds vs adult wording, and just choose the codes based on the patient's age.
 
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