COVID-19 PRE-OP CODES

thomas7331

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I'm assuming you mean Z01.812? Per the ICD-10 guidelines: "For patients receiving preoperative evaluations only, sequence first a code from subcategory Z01.81, Encounter for pre-procedural examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation."

You may find that some payers will accept it as the only diagnosis, but for correct coding you should also assign the code that code for the condition for which the patient will be having the procedure. Z11.52 would be incorrect in this situation because this is not a screening service - this is a service being provided as a component of a treatment plan for a patient's problem.
 
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I am a CPC but I work insurance claims denials. We have hundreds of claims denied because the coders are assigning Z11.59 to pre-procedure covid testing, because the physician's order says "special screening exam for viral disease" or "screening for viral disease." We are able to see in the chart that the patient had a procedure 1-3 days following the covid test so we know that it's a pre-px text, but our coders are saying they can't or won't change it to Z01.81* because the physician did not state on the order that it is a pre-px test. They are asking me to write all of these off, but I would like to get clarification if it is compliant to use the Z01.81* dx code, or if we have to use Z11.59 due to the physician's statement on the order.
 

thomas7331

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I am a CPC but I work insurance claims denials. We have hundreds of claims denied because the coders are assigning Z11.59 to pre-procedure covid testing, because the physician's order says "special screening exam for viral disease" or "screening for viral disease." We are able to see in the chart that the patient had a procedure 1-3 days following the covid test so we know that it's a pre-px text, but our coders are saying they can't or won't change it to Z01.81* because the physician did not state on the order that it is a pre-px test. They are asking me to write all of these off, but I would like to get clarification if it is compliant to use the Z01.81* dx code, or if we have to use Z11.59 due to the physician's statement on the order.
Z11.59 is an incorrect code for a COVID test in any case.

If the medical record does not show that it is a pre-procedural test, you cannot use Z01.81- as a diagnosis. However, the guidance has been given (see below) that a screening diagnosis should not be used during a pandemic because exposure is presumed. The correct code diagnosis code for COVID testing of an asymptomatic patient is Z20.828 (or Z20.822 for dates of service on or after 1/1/2021).


Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19 | AHA

How should an encounter for screening for COVID-19 be coded, such as a patient being tested for COVID-19 as part of preoperative testing? Should code Z11.59, Encounter for screening for other viral diseases be assigned? (8/5/2020)


During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (code Z20.828).

For an encounter for COVID-19 testing being performed as part of preoperative testing, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and assign code Z20.828 as an additional diagnosis.

Note: This advice is consistent with the updated ICD-10-CM Official Guidelines for Coding and Reporting that become effective October 1, 2020. During these unprecedented times, AHA and AHIMA concluded it was necessary to clarify the appropriate codes for COVID-19 testing in advance of the effective date for the revised official coding guidelines.
 
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Thank you Thomas for your quick reply. I do want to clarify, because I am getting so much push back from our coders, when you say "the medical record", are you saying the actual order for the covid test, or the patient's chart? We can show in the chart that the test is followed by a procedure in 1-3 days. The actual order itself, however, gives "screening for viral disease." If the order needs to indicate "preprocedural covid test" then we need to educate the providers to make that change.
 

thomas7331

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Thank you Thomas for your quick reply. I do want to clarify, because I am getting so much push back from our coders, when you say "the medical record", are you saying the actual order for the covid test, or the patient's chart? We can show in the chart that the test is followed by a procedure in 1-3 days. The actual order itself, however, gives "screening for viral disease." If the order needs to indicate "preprocedural covid test" then we need to educate the providers to make that change.
The 'medical record', for diagnosis coding purposes, is the documentation by the provider - only a provider can make a diagnosis. So you can code from the reason for the test that the provider gave on the order, or you can code from the documentation in the provider's notes if that gives the reason for the test as being a pre-procedural exam. You can't assume that is the reason just from seeing that the patient had a procedure done. So yes, I agree that some provider education is needed here if the intent of the test was in fact pre-procedural but the providers are just calling it a screening.

However, I still would argue that your coders are incorrectly using Z11.59 based on the guidelines that have been issued. This is an exceptional situation and instructions are that a screening test for the COVID disease is to be coded as Z20.82- for the duration of the pandemic. Payers are aware of these guidelines and have likely programmed their claims systems to recognize Z20.828 and Z20.828 but not Z11.59.
 

csperoni

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I would not be writing these off. I agree with Thomas's recommendations and I would:
1) ask moving forward for each record to properly reflect pre-op. Physician education is definitely in order here.
2) If there is nothing on the chart indicating pre-op but you can clearly see it is by other records, perhaps a clinician can write amendments?
3) As Thomas mentioned, even if it's not pre-op, Z11.59 is not the correct diagnosis at this time.
 
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The 'medical record', for diagnosis coding purposes, is the documentation by the provider - only a provider can make a diagnosis. So you can code from the reason for the test that the provider gave on the order, or you can code from the documentation in the provider's notes if that gives the reason for the test as being a pre-procedural exam. You can't assume that is the reason just from seeing that the patient had a procedure done. So yes, I agree that some provider education is needed here if the intent of the test was in fact pre-procedural but the providers are just calling it a screening.

However, I still would argue that your coders are incorrectly using Z11.59 based on the guidelines that have been issued. This is an exceptional situation and instructions are that a screening test for the COVID disease is to be coded as Z20.82- for the duration of the pandemic. Payers are aware of these guidelines and have likely programmed their claims systems to recognize Z20.828 and Z20.828 but not Z11.59.
Thank you so much! That has been my position, that Z11.59 is inappropriate, regardless. I am forwarding this on to management to push for having the dx changed to Z20.828, and educating the providers going forward.
 
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