ICD10 Z00.110

kschulte71

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I am getting denials from insurance companies requiring us to bill to the highest level of specificity. This is the code that was used. According to Craneware.com, it states that a +7 digit is required but my coder is stating there is not one. Obviously the insurances read it the same way we are and are requiring this additional code. Can anyone help me find what the options for +7 codes are?
 

Estherrani

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Good day,

ICD 10 Z00.110 would be the routine or screening examination code inwhich most of the insurance companies denies especially medicare hence it is appropriate to find whether any other diagnostic info present in the documentation or it would lead to appealing the claim.

Thanks,
Esther Immanuel,CPC.
 

mitchellde

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You will need to have the Z00.110 linked to either the CPT code 99381 or 99391, so the question is how exactly did you use this code and what other codes were on the claim. there is no other code for a routine well baby check under 8 days old.
 

kschulte71

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You will need to have the Z00.110 linked to either the CPT code 99381 or 99391, so the question is how exactly did you use this code and what other codes were on the claim. there is no other code for a routine well baby check under 8 days old.
My Coders are telling me that a 7th digit is not required that Z00.110 is the highest level of specificity. so should a '0' be added to the end of the code?
 
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Your coders are correct, and a 7th digit is NOT required. Z00.110 is the highest level of specificity, and no additional digits are required. I don't subscribe to craneware.com that you mention, but both my Optum360 ICD10 book and supercoder.com state this. Of note, this is a code that is noted for primary dx only, yet unacceptable principal diagnosis for inpatient admission per Medicare Code Edits. From my ICD10 book:
NOTE: Please note that the symbols indicating the Z code "principal or first-listed only" designation & the Z codes that may be principal or first-listed diagnoses included in the official coding guidelines are consistent with reporting guidelines for health care encounters EXCLUDING ACUTE CARE INPATIENT ADMISSIONS. These Z code edits are often in conflict with the inpatient prospective payment system [IPPS] edits. For example, Z34.90 encounter for supervision of normal pregnancy, unspec, unspec trimester, may be an appropriate primary reason for an outpatient encounter. However, supervision for a normal pregnancy is not an acceptable principal diagnosis or reason for an inpatient admission and will have an unacceptable principal diagnosis edit under IPPS.
Your denial may be related to this, as there is no 7th digit for that code.
I hope this helps.
 

mitchellde

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My Coders are telling me that a 7th digit is not required that Z00.110 is the highest level of specificity. so should a '0' be added to the end of the code?
You can never add a digit or any character to a code if it is not part of the official code set. Use your code book to verify that this code is correct. More importantly verify that the code has been used in the correct context. The software you are using is incorrect in stating that a 7th character is required. The code set is created by the WHO and is mandated for use by HIPAA, you cannot change the codes in any way or change the rules of their use.
 
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Recommend checking for other errors. What is the age of the patient? Only report Z00.110 for infants under 8 days of age (day of birth is day 0). Report Z00.111 for preventive care for 8-28 days. Unless the plan is not subject to ACA requirements, all preventive care recommended by Bright Futures is covered but correct codes must be assigned. (Also, denials from health plans can be due to errors in their electronic systems. It never hurts to verify your codes are correct and then call to discuss with health plan representative.)

Hope that helps.
Cindy
 
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