Sick and well visits billed on same date 2017 rule

williafm

Networker
Messages
27
Location
NONE
Best answers
0
Does icd 10 really restrict same day sick and well visits? After reading the article in the july issue of the aapc magazine , me and my fellow coder agreed with what is stated however, our corporate office doesnt agree with the article and states there are no changes needed by our providers in how they code these . Why is there nothing anywhere else about this? The article is well written and does explain why very clearly . Just cant find any references to this anywhere else

confused in virginia

thanks
 
Messages
350
Best answers
0
well and sick on same date

Does icd 10 really restrict same day sick and well visits? After reading the article in the july issue of the aapc magazine , me and my fellow coder agreed with what is stated however, our corporate office doesnt agree with the article and states there are no changes needed by our providers in how they code these . Why is there nothing anywhere else about this? The article is well written and does explain why very clearly . Just cant find any references to this anywhere else

confused in virginia

thanks
I believe an updated article will be published soon. Recent AHA Coding Clinic for ICD-10-CM guidance disputes the interpretation that a well and sick visit cannot be reported on the same date (see below).

Coding Clinic (2016 Vol3 No1) states the following which supports that a child presenting with symptoms can receive both preventive and problem-oriented care at the same encounter:
“Well-Child Examination with Abnormal Findings (2016 Vol3 No1)
Question: A four-month-old female infant is seen for a well exam. The mother reports that the baby has had a runny nose for one week. The baby has been fussy, but without fever, cough, vomiting or diarrhea. On examination, the tympanic membrane was noted to be red and bulging. The patient is diagnosed with acute right suppurative otitis media. How would this encounter be coded?
Answer: In this case, it would be appropriate to assign code Z00.121, Encounter for routine child health examination with abnormal findings, as the first-listed diagnosis. Assign code H66.001, Acute suppurative otitis media, without spontaneous rupture of ear drum, right ear, as an additional diagnosis. The abnormal diagnostic finding is acute suppurative otitis media. During a routine exam, when a diagnosis or condition is found, it is coded as an additional diagnosis.”

The child in this example presents with a runny nose for a week and fussiness that turns out to be related to an ear infection. The child was not well at presentation for the scheduled preventive services (and some patients, unfortunately, are never well) yet Coding Clinic advises to assign codes Z00.121 and H66.001 because each code describes a reason for the services rendered.

Regarding the instructions from CPT®, I disagree with the interpretation that the instruction, “If an abnormality is encountered or a preexisting problem is addressed…,” would preclude the instance when the abnormality is encountered due to patient presentation with signs or symptoms. This is neither stated nor in line with common interpretation of the instruction. Finally, neither code set serves as a standard of care that would override a physician’s clinical judgment regarding what care may be appropriately delivered at one encounter. ICD-10-CM is a classification of diseases and not a clinical practice policy or guideline.

I hope that helps.
Cindy
 
Top