covid coding screening z11.59

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Can Z11.59 be a primary dx? Everything I have read suggests that it can in fact be primary. I got a rejection from BCBS stating service not payable for screening service.
 

thomas7331

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Yes, it is a valid primary diagnosis, but I would question whether or not it is the correct code. A screening, in ICD-10 terms at least, means that the patient is having the test solely as a preventive measure - in other words, they do not have any symptoms of the disease, they have not had contact with any sick persons or persons suspected of having the disease, no exposure or other reason to need the test. We are not really at the phase of this disease yet where we are beginning to conduct screenings of the healthy population.

But if in fact the code is correct, then the denial is probably correct also. All insurance plans have very specific and limited coverage for preventive services listed in the patients' plans, so I would not be surprised at this early stage in the disease, if the test would only be covered for patients who are symptomatic or who, due to exposure, have a demonstrated medical need for the test. If a screening is not a covered benefit for the patient, then it's the patient's responsibility - it's not due to a problem with the coding.
 
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kayleeevans907

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I'm receiving issues from Medicare on this as well. Granted we are only using Z11.59 for asymptomatic/no known exposure patients. I've posted my own thread with Medicare specific questions but want to follow this too to see if anyone else has more insight.
 

Cady4217

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I am seeing the same denials for medicare, we billed a 99444 for telehealth with the screen dx. I'm wondering if they don't like it with telehealth bc they are more or less looking for the covid test itself?
 

thomas7331

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The AHA issued guidance in July that screening codes are not appropriate during a pandemic and that testing of asymptomatic patients for COVID-19 should be coded with Z20.828 instead.

Medicare only covers limited preventive and screening services as specified in the law and screening for viral diseases is not one of them, so that it most likely the reason if you are seeing denials.
 

csperoni

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