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SOB?

dballard2004

dballard2004

True Blue
Messages
1,325
Location
Overland Park, KS
Patient was referred to the pulmonologist for SOB. She denied any symptoms at all at the visit and reported no specific complaints. Provider selected a 99203 with a dx code for the SOB. The coder changed the dx to Z00.00 since there was no SOB present. The claim denied for the Z code and E/M (99203) combo. Provider feels the coding of SOB is correct since the patient was referred for evaluation of shortness of breath, which is a valid reason for the encounter. Even though the patient denied symptoms during the visit, the referral reason and medical necessity for evaluating the complaint still existed at the time of the encounter.

Thoughts?
 
Depends on the documentation. However, you would have to follow ICD-10 guidelines. It wouldn't be correct to use Z00.00. That's not why they were there and it is not explaining the visit.
Why wouldn't it be more like Z03.89 + Z87.09 area? It is denied because you don't have a preventive visit w/ the Z00.00. Is it completely resolved or are they still having issues intermittently just not right at the moment of the visit? Was there a workup, full exam, etc.? One time visit with no f/u? Any other underlying, related complaints?
 
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