These are codes that acknowledge emotional or behavioral symptoms while deferring a specific diagnosis for up to six months. We’ll cover other codes in future posts, so make sure you subscribe to the TherapyNotes™ blog below for more helpful information.
Come October 1st the healthcare industry begins to use the new diagnosis coding regimen and with that transition the ambulance billing industry will face a new set of rules and billing guidelines to follow including the Z codes. When some circumstance or problem is present which influences the person’s health status but is not in itself a current injury or illness.
The largest Medicare Administrative Contractor (MAC) in the United States is mandating the use of five Z codes is why. While we have not heard of another MAC that will enact this requirement, it’s still good information to share with everyone in the blogosphere as the basic principles of medical necessity and reasonableness exist across all billing platforms, whether your EMS agency resides in the Jurisdictions where Novices accepts claim processing responsibility.
First, take a minute to review the CMS definition of medical necessity of an ambulance patient. We’ve blogged on it in the past so hit the archives or simply check out the definition on the CMS website.
This will involve patients who are known to be treated in a psychiatric situation requiring one-on-one monitoring by members of the ambulance crew for any type of reactive psychosis and/or are acting out exhibiting involuntary or voluntary movements. EMS providers will be documenting in great detail patients’ conditions requiring and the presence and active use of certain life-sustaining, enabling machines during the transport.
Z76.89 will be required to explain an ambulance transport of a “Person Encountering Health Services in Other Specified Circumstances.” When your PCR documentation documents a patient who is transported by ambulance but did not require the services of the ambulance crew, then your billing office will be required to use this secondary code to report the scenario when billing to Novices/Medicare Part B and will spark a denial for payment. EMS providers must be truthful when documenting ambulance transport scenarios even if it means that the claim will be denied when the patient’s medical necessity cannot be established and the trip is considered to not be reasonable for payment from the Medicare Part B program.
As another example, Medicare will not pay a laboratory claim if Z00.00 Encounter for general adult medical examination without abnormal findings is submitted for rendered services. If a code from this section is given as the reason for the test, the test may be billed to the Medicare beneficiary without billing Medicare first because the service is not covered by statue, in most instances because it is performed for screening purposes and is not within an exception.
Code X37.0- also should be assigned when an injury is incurred because of flooding caused by a levee breaking related to the hurricane. Resources Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM): www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201710_ICD10.pdf ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath August 2017: www.cdc.gov/nchs/data/icd/Hurricane_coding_guidance.pdf Julie Pisa cane, COMA, PPM, CEC, CRC, CCA, is employed at NYU Lang one Health as a professional billing compliance specialist.
Note Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed.
2016 2017 2018 2019 2020 2021 Non- Billable /Non-Specific Code This can arise in two main ways: (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
Codes for acute injuries (mainly found in chapter 19) and fractures, however, do allow for seventh characters. In this ICD10 Monitor article, Lauri Gray, HIT, CPC, writes, “Aftercare visit codes cover situations occurring when the initial treatment of a disease has been performed and the patient requires to be continued care during the healing or recovery phase, or care for the long-term consequences of the disease.” Post-op care falls into that bucket when the condition that precipitated the surgery no longer exists, but the patient still requires therapy care to return to a healthy level of function.
In situations where it’s appropriate to use Codes, “aftercare codes are generally the first listed diagnosis,” Gray writes. Let’s also assume that, as a result of the surgery, the patient is no longer suffering from osteoarthritis.
If the line between acceptable and unacceptable uses of aftercare codes still seems a bit fuzzy, just remember that in most cases, you should only use aftercare codes if there’s no other way for you to express that a patient is on the “after” side of an aforementioned “before-and-after” event. V Codes (in the DSM-5 and ICD-9) and Codes (in the ICD-10), also known as Other Conditions That May Be a Focus of Clinical Attention, addresses issues that are a focus of clinical attention or affect the diagnosis, course, prognosis, or treatment of a patient's mental disorder.
Z60.2 Living alone Z60.3 Acculturation difficulty Migration Social transplantation Z60.4 Social exclusion and rejection Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behavior. Z63.0 Problems in relationship with spouse or partner Discord between partners resulting in severe or prolonged loss of control, in generalization of hostile or critical feelings or in a persisting atmosphere of severe interpersonal violence (hitting or striking).
There are lots of life’s problems that need attention, but they don’t fit neatly under our definition of a mental illness. As a result, most insurance providers won’t pay for treating these problems or if they do there are severe limits on the amount of counseling that you can get for these issues.
That does not mean they are not important, but it does mean that generally, we don’t see them as an illness, more like a challenge the person must face and overcome. Some of these are the kind of issues that make the news, the partners who kill each other, and the extreme cases of child abuse.
They need treatment, but we can’t say that every couple who fights is mentally ill. What we can say is that killing your spouse is not normal or acceptable. Marriage, family, and child counselors specialize in just these issues.
Victims of abuse, neglect or violence get a special status in the DSM and their treatment is found under the 995.xx codes, which are almost always paid for by society. The person doing the abuse or neglect gets the “V” code and mostly has to pay for their own treatment.
The last group of things that may need attention but don’t get counted as full mental illnesses are things that people do, other than abuse or neglect, that we as a society do not like. The term “Behavior” is used here to differentiate those who don’t know that what they are doing is wrong or can’t control themselves as in Antisocial Personality Disorder vs. those who know it is wrong and do it anyway, as in Antisocial Behavior.
All these things and many more may be good reasons to see a counselor or therapist even if you don’t have a diagnosable mental illness. I’ve been working on this book for several years, but now seem like the right time to publish it.
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