Wiki Z01.00 vs Z01.01

[ValerieDUP!]

I am curious if anyone is having trouble getting Z01.01 processed as a routine visit. For example, patient schedules yearly exam. During exam all findings are normal accept the patient mentions that they occasionally have headaches or dry eye. We are using 92xxx CPT codes and use Z01.01 as the primary dx and whatever the other issue is secondary. Some insurances are processing the claim as routine and using the patient's eye benefits but other insurances (Aetna for example) state that when Z01.01 is used it is no longer a routine visit and processes as medical. I am just looking to see how other offices are coding these situations to make sure we are doing it appropriately.

 

[mitchellde]

It is not an abnormal finding if it is a complaint/symptom expressed by the patient. If the patient has a symptom/complaint then the exclude 1 note directs you to code only the symptoms.