I'm going through the CPC practicum and have found myself stumped by a couple cases. Is there a hard and fast rule on when an encounter code should be used? Out of the 28 I've done so far, only two of them required such a code, and there doesn't seem to be any commonality between them. So, how does one know when an encounter code is appropriate/necessary?
No, not specific case at this point, but thank you for pointing out that section.I'd suggest reviewing the ICD-10 Guidelines for Routine and Administrative Examinations. (Found under Chapter 21, C, 13)
Do you have questions about any specific cases?
No, not specific case at this point, but thank you for pointing out that section.
I noticed the commonality between the two test cases now, in this case both were cosmetically related.
This still leaves me stumped on something. There's such a limited range of "Encounter for" codes, no where near enough to account for all possible reasons for an encounter.
For example, there is encounter for cosmetic surgery, for contraceptive management, and for immunization. There is no encounter for, lets say, appendectomy, or vertebral fusion, etc.
Somehow, I doubt there's a clean and easy answer but... where's the logic?
Ah, that makes some sense! My mind didn't really interpret that cleanly.It's stated in the guidelines:
"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. 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."
In your hypothetical example for the appendectomy or vertebral fusion, you'd code the condition that caused the need for the surgery.
A routine physical or a pre-employment physical doesn't have a definitive diagnosis that is the reason for the condition, so the Z encounter code is used.