ICD-10 Wellness Code Advice Needed

kittychang

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In Chiropractic and PT, many patients elect to continue care, paying out of pocket and most often, providers are directed to use HCPCS code S8990 to describe that service. We have always been counseled to use one of the following, non-payable, generic ICD-10 code:

Z00.00 "encounter for general adult medical examination"
Z00.8 "encounter for other general examination"
Z13.828 "encounter or screening for musculoskeletal disorder"

With regards to the instructional note for "Persons encountering health services for examinations Z00-Z13" the question is, what is considered 'health services" or "limited care"? Does maintenance care, procedure code S8990 fall into the category as health services or limited care as listed in the Z codes?

We have also been advised to use this code, based on the fact that a procedure is performed:

Z41.8 "encounter for other procedures for purposes other than remedying health state"

Instructional notes for this category Z40-Z53 says: "are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state"

For example, office notes would NOT have a medically necessary encounter...could say something like "Patient has some stiffness in low back and feels he needs an adjustment to assist with performing in sport activities. Normal ADLs. Normal ROM"

That said, is there one of these that makes more sense than another, or should we consider that since we are not seeking third-party reimbursement, it really doesn't matter?
 

mitchellde

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I am not sure I understand your question so let me address what I see.
You could not use Z00.00 since you are not performing a general adult exam
You cannot use Z00.8 because again you are not performing a general exam
you cannot use the Z13.828 unless the patient is completely asymptomatic and you have some criteria for the screening such as family history
for Z41.8.. as the category indicates this is a code for aftercare. It implies that the condition has resolved after performing a procedure and you are providing a surveillance to assure there is no residual issues.
from the example you provided:
For example, office notes would NOT have a medically necessary encounter...could say something like "Patient has some stiffness in low back and feels he needs an adjustment to assist with performing in sport activities. Normal ADLs. Normal ROM"
the only dx code you can assign for this note is back stiffness as that is what the provider documents as the reason for the patient encounter. None of the other codes you suggested applies to this note.
 

kittychang

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Still seeing answer

Thank you for your response....I think you may have been distracted by the example...there are plenty of times when stiffness is there but it's not medically necessary. We're trying to come up with the code that is going to describe that there is no "condition" being treated, it's simply for wellness....even if I have a small ache or stiffness. I don't want the insurance company to even consider paying for it. Any other thoughts?




I am not sure I understand your question so let me address what I see.
You could not use Z00.00 since you are not performing a general adult exam
You cannot use Z00.8 because again you are not performing a general exam
you cannot use the Z13.828 unless the patient is completely asymptomatic and you have some criteria for the screening such as family history
for Z41.8.. as the category indicates this is a code for aftercare. It implies that the condition has resolved after performing a procedure and you are providing a surveillance to assure there is no residual issues.
from the example you provided:
For example, office notes would NOT have a medically necessary encounter...could say something like "Patient has some stiffness in low back and feels he needs an adjustment to assist with performing in sport activities. Normal ADLs. Normal ROM"
the only dx code you can assign for this note is back stiffness as that is what the provider documents as the reason for the patient encounter. None of the other codes you suggested applies to this note.
 
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