Wiki z00.00 vs z00.01

[KayleeWard]

Hi all,

Might be a dumb question but I am newer to the coding world. I code outpatient pathology and providers use z00.00 all the time. I'm confused as to why we aren't using z00.01 more when they also have on their about six other complaints like elevated prostate antigen, high BP, hyperkalemia etc. Would it be inappropriate for me to use z00.01? Medicare doesn't accept z00.00 anyways, right? Thank you so much.

 

[Pam Warren]

That code shows up on the order because it typically flows from the preventive visit that was done at the same time the order was written. You're right, Z00.00 won't be covered by Medicare, and technically, if the patient has a condition, the provider should be ordering surveillance labs with a medical diagnosis and not preventive labs.
You should code only based on the order..... and it would be up to your lab to get back to the provider with a more appropriate diagnosis code. This scenario is a hot mess, and problematic everywhere--but many labs won't go back and ask for a different order; they'll process the lab with the Z code and balance bill the patient, (which they can do....but their billing office gets inundated with phone calls). Nice catch and good question.

 

[Pam Warren]

That code shows up on the order because it typically flows from the preventive visit that was done at the same time the order was written. You're right, Z00.00 won't be covered by Medicare, and technically, if the patient has a condition, the provider should be ordering surveillance labs with a medical diagnosis and not preventive labs.
You should code only based on the order unless you have the provider's progress notes and can abstract correctly)..... and it would be up to your lab to get back to the provider with a more appropriate diagnosis code. This scenario is a hot mess, and problematic everywhere--but many labs won't go back and ask for a different order; they'll process the lab with the Z code and balance bill the patient, (which they can do....but their billing office gets inundated with phone calls).