Wiki Routine exams

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nc_coder

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I noticed with I-10 there is a code for General medical exam with abnormal findings (Z00.01) and without abnormal findings (Z00.00). Will the use of these codes make it unnecessary to use a Preventive CPT and separate E/M? Ex: 99395, 99213-25
 
According to the 2010 Dec CPT assistant when the primary reason for the encounter is preventive then there can be no copay. This was the reason for the 33 modifier. TO avoid a co-pay then you can bill one visit level that is calculated using the entire note and append a 33 modifier. By doing this the patient will not have a copay and the visit is treated as the annual visit. Some consultants are saying to bill the preventive and the ov with the 33 but I am having a hard time with that one working. Also note that the ICD-10 CM Z00.0- codes cannot be billed with signs and symptoms only abnormal findings.
 
The ICD-10 CM Codes for annual exams will make it very difficult to charge an ov with a 25 modifier and a preventive exam. I will not say it will be impossible as any thing is possible at this time but it will be difficult to justify when the primary reason for the visit is preventive. Does this help?
 
No, the ICD-10-CM Code will support the CPT code and you will continue to report professional services with a CPT code such as preventive visit codes.

When reporting a "Significant and separately identifiable" E/M on the same date, an ICD-10- code describing the condition that warranted the E/M service would be reported along with the E/M level of service CPT code.

The ICD-10 code "Z00.01Encounter for general adult medical examination with abnormal findings" would not necessarily indicate that something had to be addressed in addition to the preventive exam. This code would indicate that the exam was routine in a patient who does have abnormal findings (chronic diseases or congenital conditions, for example) and not treated on that day.
 
I disagree. Abnormal findings are those FINDINGS discovered at the time of the exam that are not normal for this patient given their pre exisiting conditions. The Z00 and Z01 maid description states without complaint, suspected, or reported diagnosis.
A patients existing chronic conditions or congenital conditions are their reported diagnosis and are not abnormal for this patient when they present for their wellness visit. This patient is as well as they can be. However if on presentation for a wellness the provider discovers a lab value that is out of normal range (the patient had not complaint or concern) then that is an abnormal finding.
This exclusion of signs and symptoms or other suspected or reported conditions does not allow for the reporting of an OV with a preventive.
Again the affordable care act says that when a patient presents for primarily preventive services then the patient cannot be assess a separate co pay.
I know we will be arguing this point for many years to come. This is why I have done exhaustive research on this issue. There is nothing in ICD-10 CM that will support a preventive exam and an office visit on the same day unless the provider documents an abnormal finding, something over and above the norm for this patient.
 
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