Wiki Z01.818 preop testing

[tumbles025]

I need input for an issue. I keep getting encounters returned stating Z01.818 can't be the principle dx for preop x-rays and EKG's because it is not a covered diagnosis. I am told I need to move this diagnosis code to secondary to get the test covered. I am not comfortable with this at all and need to get suggestions about how to handle this.

thank you
Jayne Grady

 

[mitchellde]

Per guidelines Z01 codes are first-listed only allowed so you could never use them as a secondary code. Perhaps you need to be more specific like using the Z01.810 and Z01.811 codes for cardiovascular and respiratory symptoms examinations.

 

[TThivierge]

Dx Z01.818 Preoperative Evaluation before surgery

Hi Jayne

I would ensure the doctor gives you why the person is getting surgery mentioned in the medical documentation. I then would list this as primary dx code, then the Z code last. This Z01 dx code is a first listed dx code but it depends on the payer regulations in regards to billing. So check this out first
Some of my payers I put this first dx. code then others it is last dx code in accord with other medical problems the patient has for the day per the doctor's dx codes given for processing the claim.


Have a great day

 

[mitchellde]

Coding guidelines are HIPAA mandated to be adheared to. So this applies to all payers with the exception of work comp and most auto. Otherwise the payer must follow coding guidelines. Coding guidelines indicate these are first-listed only allowed codes so they should never be placed as secondary codes on claims.

 

[thomas7331]

I agree with Debra, this code must be first. If the primary purpose of the encounter is a pre-operative visit, the Z code should be listed first and the condition requiring surgery second. Some pre-operative services are simply not covered by payers. It would be a misrepresentation of the service to put a different diagnosis in the first position in order to obtain payment for a non-covered service.

 

[TThivierge]

Adding modifier 57 to CPT code with dx Z01.818 dx

Hi

To add to the discussion adding modifier 57 is used with the Eval/mgnt CPT code if the physician is discussing a surgery procedure to take place in the next 90 days.