I understand the rationale behind not assigning the excludes1 dx codes with the Z00.0-Z01. category, but ICD-10 is not designed for claims and reimbursement it is designed for accuracy in assessing reasons for visits, diseases and conditions, so if that is the case, the rules governing billing for separate EMs using sick dx codes would come from the insurance side of things, as well as CPT usage. I still believe that as long as I do not attach the excludes1 dx codes to the wellness, but attach them to the sick EM visit, that I'd be correct, so long as the sick EM is justified (ie. not found on exam, but actual HPI elements). I could be wrong, but right now, that's how I'm thinking, since we're not into ICD-10 yet. At this point, I'm just trying to know when it's ok for a provider to charge separately for an EM. Thx