Wiki To bill Preventative or Not to bill Preventative???

[KCORBETT92]

I'm running into issues billing for several of my sites...

The doctors will have the CC as "follow-up" or "routine" sometimes even "dm check 6-months" and there is always a full workup but the doctor puts like, 7-10 diagnosis codes in there, usually insignificant things like HTN, DM, obesity, etc... my problem lies where they keep putting the final diagnosis code as "Z00.00" this is troublesome to me because I never know- do I bill preventative CPT or E/M CPT?!

At first, I was trying to bill based off what the CC/HPI said but even then, it can be unclear which I should bill. For example, a visit will say something like "Patient presents for routine DM visit. Taking all meds as directed without side effect." and then will go on to be very detailed like a prevent visit, but then have 7 diagnosis including Z00.00. WHAT DO I DO?!

 

[Cole1971]

bill preventtative or not to bill preventative?

I'm running into issues billing for several of my sites...

The doctors will have the CC as "follow-up" or "routine" sometimes even "dm check 6-months" and there is always a full workup but the doctor puts like, 7-10 diagnosis codes in there, usually insignificant things like HTN, DM, obesity, etc... my problem lies where they keep putting the final diagnosis code as "Z00.00" this is troublesome to me because I never know- do I bill preventative CPT or E/M CPT?!

At first, I was trying to bill based off what the CC/HPI said but even then, it can be unclear which I should bill. For example, a visit will say something like "Patient presents for routine DM visit. Taking all meds as directed without side effect." and then will go on to be very detailed like a prevent visit, but then have 7 diagnosis including Z00.00. WHAT DO I DO?!

I would be interested in the answer to this question also.?
Thank you

 

[Chelle-Lynn]

It sounds like this may be a discussion point with the physician to get better clarification on their intent on these visits. Some providers like to perform full exams when they have patients with a boatload of issues such as diabetes, hypertension, obesity as these can lead to other problems. Often times we see physician listing the Z00.00 incorrectly....

• In most cases the physicians add this code as they are providing a thorough exam without a full understanding of the dx code.
• In the scenarios you are listing it sounds like the patient is coming in for check-ups and follow up on chronic conditions and not just for the sole purpose of a physical.
• The full exam and the use of Z00.00 is most likely to double check that there are no new problems or complications from the chronic issues.
• Based on this I would code these with a regular E&M and not a preventative.

However to ensure good communication and possible training for both of you; I would follow up with the physician for a clearer understanding and his intent when using Z00.00.


Side note...

• The Z00.00 code would be incorrect for preventative as the patient does have abnormal findings so the dx should be Z00.01 if this is a true preventative visit.