Wiki Encounter for a high risk pulmonary embolism

[jpeace01]

Hello,

I am trying to find the right encounter code for a patient who is at high risk of a pulmonary embolism/DVT as there is a family history. The patient themselves do not have any active PE or DVT. I have tried billing out Z76.89 but, was denied. Should I just be billing out the code for the family history? Or is there encounter code that I should be billing out as primary? Any help would be greatly appreciated.

 

[Orthocoderpgu]

If the patient was experiencing signs or symptoms, those should be used. Another code to consider depending on the circumstances is Z71.1. If the patient has a family history using the family history code helps paint the total picture of why the patient is being seen.

 

[thomas7331]

If there is a confirmed genetic susceptibility to the disease, then there are other codes that would support that. However, if the patient is asymptomatic and the patient's family history is the only documented reason for the encounter, then that's what you'd have to use - it is a valid primary diagnosis code and is more specific than Z76.89. If it causes a denial, I would suggest sending an appeal.

 

[jpeace01]

If there is a confirmed genetic susceptibility to the disease, then there are other codes that would support that. However, if the patient is asymptomatic and the patient's family history is the only documented reason for the encounter, then that's what you'd have to use - it is a valid primary diagnosis code and is more specific than Z76.89. If it causes a denial, I would suggest sending an appeal.

Thank you, this was very helpful!