Debra, I always respect and appreciate your opinions and insights, and have learned much from you. Based on the information below, I have to respectfully disagree with you on coding a routine visit and sick visit at the same time. I am really, as I'm sure most others are as well, trying to fully understand the new guidelines and rules. One would think after all this time, that the WHO, and/or CMS would be more specific in the guidelines, eliminating the need to interpret or speculate.
Regarding when to use routine exam with abnormal findings codes, it was my original understanding that any time a patient had an existing condition that the 'with abnormal finding' should be used. Although, to me, it definitely makes more sense to use the abnormal findings code based on that specific routine exam results, not 'pre-existing' chronic conditions. However, this article reinforces my original understanding. I would greatly appreciate other sources stating that the 'with abnormal findings' codes should only be used based on lab/test/exam results for the current routine encounter.
This article from the American Academy of Pediatrics states:
"...
any abnormality that is present at the time of the routine examination
may lead to reporting Z00.121 and a secondary code to describe the finding. This may include, but not limited to an acute injury, an acute illness, an incidental or trivial finding that is diagnosed in the patient?s chart, an abnormal screen, an abnormal exam finding (eg, scoliosis), a newly diagnosed chronic condition, or a chronic condition that had to be addressed (excluding medication refill) due to it being uncontrolled or new issues arising."
Regarding routine and sick visit coding at the same time (supported of course):
The article also answers this question:
"Q.
If we report the Z00.121 (health exam with abnormal findings) code, are we required to report a CPT code for a ?sick? encounter? Also, by using this code will it negate the use of modifier 25?
A.
Please be aware that the new ICD-10-CM code does not impact any CPT guideline. Just because an abnormality is discovered during the routine well child exam does not mean that a separate E/M service should or can be reported.
If the criteria are met for reporting a significant and separately identifiable E/M service in addition to the preventive medicine service, then yes one should be reported. However, simply reporting the Z00.121 does not automatically equate to a separate E/M service. As for modifier 25, again CPT guidelines will not be effected, therefore, yes if you are reporting 2 distinct E/M services, then modifier 25 is still required on the ?sick? office visit code."
https://www.aap.org/en-us/Documents/coding_faq_coding_encounters_icd_10.pdf
I have been scouring the internet, as I'm sure others are as well, looking for more definite guidance on these important issues. If anyone has other sources, please post. This is a great thread!
Arrana Ashton, CPC, CEMC