Wiki Well Child Visit with minimal issue

[twalls]

So, I have this ongoing issue with a provider that wants to add every issue as an E/M to a WCV and would like some feedback from some more seasoned Peds coders.

• If a child comes in for WCV and says two days ago I fell and my wrist hurts, Dr examines the wrist, states its tender, orders xrays- I say this is not a 99214- a stretch even a 99213. No mention of ice, nsaids, ect.
• Child comes in for WCV and combines it with ADHD visit, Dr states, no changes to meds, doing well in school, no loss of appetite- I say not a 99214, should this of been billed separately could of been a 999213 if documented properly.
• Baby comes in for WCV, mom says baby has diaper rash, Dr says try some Desitin, 99213- I say no charge. What instances are clearly appropriate to add a problem visit (25) to the WCV?

Look forward to some input! Thank you as always!

 

[mitchellde]

ICD -10 codes state
Z00 - encounter for general exam without complaint, suspected, or reported diagnosis. None of the scenarios you list indicate abnormal findings, they all state presenting complaints. You can either do an ov or a preventive but really not both. Also chances are very good you do not have documentation to support a full preventive and a separate 99214 or 99213. Remember you cannot duplicate elelements of one level to the other. I know that many offices do bill for both, however it does not make it correct or compliant.

 

[twalls]

ICD -10 codes state
Z00 - encounter for general exam without complaint, suspected, or reported diagnosis. None of the scenarios you list indicate abnormal findings, they all state presenting complaints. You can either do an ov or a preventive but really not both. Also chances are very good you do not have documentation to support a full preventive and a separate 99214 or 99213. Remember you cannot duplicate elelements of one level to the other. I know that many offices do bill for both, however it does not make it correct or compliant.

Thank you for your response. This certainly makes sense to me although the provider does not want to bring them back for an additional visit and will use the abnormal findings dx with the additional dx's and charge for both the wcv and e/m. I can see not wanting to bring them back, convenience, timing, ect but not everyone!

 

[mitchellde]

I don’t know how to help you, it would be incorrect to use the code for with abnormal finding when the documentation does not support that this was a finding but was an expressed symptom by the patient. I Tim’s a problem. I usually leave the symptom codes with the prevent for no abnormal finding and report only the preventive E&M, like I said the documentation I have seen will never support a separate visit level.