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Z00.00 vs Z00.01 when do you code abnormal?

  1. #1
    Default Z00.00 vs Z00.01 when do you code abnormal?
    Medical Coding Books
    Z00.01 is routine exam with abnormal findings...

    So our question is....during an annual wellness exam , do we use this code only if we find a new abnormal dx or do we use this code when also coding all chronic problems reviewed from the patient's problem list during this visit??

    My DOCTOR is asking..what do you think?

  2. Default abnormal findings
    You use abnormal findings when the finding is discovered at that visit. Chronic/previously diagnosed problems are not counted.

  3. #3
    Default
    That was my understanding as well, thanks for the confirmation.

  4. Default
    this is a huge issue that no one can seem to agree on. Is there anything to reference as to the appropriate usage of Z00.00 & z00.01

  5. #5
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    Default
    The category Z00 states encounter for general exam without complaint, suspect, or reported diagnosis. The Z00.0 excludes 1 note clearly indicates that signs and symptoms may not be coded with the Z00.0 codes. The with abnormal findings addition can only then be findings by the provider discovered during the exam that are not normally present. The patients pre existing chronic problems are not abnormal findings for this patient. If one is found to not be within stable or normal parameters then this is an unexpected abnormal finding.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default Auditor, Professional Fee
    Quote Originally Posted by mitchellde View Post
    The category Z00 states encounter for general exam without complaint, suspect, or reported diagnosis. The Z00.0 excludes 1 note clearly indicates that signs and symptoms may not be coded with the Z00.0 codes. The with abnormal findings addition can only then be findings by the provider discovered during the exam that are not normally present. The patients pre existing chronic problems are not abnormal findings for this patient. If one is found to not be within stable or normal parameters then this is an unexpected abnormal finding.
    I agree that abnormal findings should pertain to the current visit and that chronic stable, problems are not "findings" during the visit are not abnormal. However, I cannot find an authoritative source that states specifically that is it correct to report Z00.00, I10, E11.9, E78.5, etc. Has anybody found this from AHA, AHIMA, AAPC? The examples all show an abnormal finding like a thyroid nodule discovered during the preventive encounter. Since the few examples that I have found all show abnormal findings discovered during the encounter, is it safe to "assume" this is correct - Z00.01 is only for abnormal findings during the routine encounter? Like an exacerbation of COPD, lumps, bumps and pains?
    Thanks a lot

  7. #7
    Question Z00.01 vs Z00.00
    Quote Originally Posted by mitchellde View Post
    The category Z00 states encounter for general exam without complaint, suspect, or reported diagnosis. The Z00.0 excludes 1 note clearly indicates that signs and symptoms may not be coded with the Z00.0 codes. The with abnormal findings addition can only then be findings by the provider discovered during the exam that are not normally present. The patients pre existing chronic problems are not abnormal findings for this patient. If one is found to not be within stable or normal parameters then this is an unexpected abnormal finding.
    I recently attended a Horizon Office Manager Informational Session (APRIL 2017) and was instructed that pre-existing conditions need to be reported annually and even in the instances of stable pre-existing conditions such as diabetes or hypertension, the Z00.01 code should still be reported even if stable. I have the handouts that state this and a certified coder verified this information. I asked personally during a Q&A session.

    All the message boards seem to point to the understanding captured in this thread that Z00.01 should be used when there's a new abnormal finding or a finding outside of the normal "parameters of that particular chronic condition". Incidentally, the word "new" and "outside of normals of chronic condition is not in the actual description of the code but we seem to use the world "new" frequently in our explanations in distinguishing the use between Z00.01 or Z00.00.

    My point is that if the insurance companies are instructing individuals one thing how are we supposed to be on the same page regarding this code

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