Codes related to preventive services are examples of this. This article will focus on how to select ICD-10 codes for immunizations, routine health exams, and common preventive screenings.
These are Codes found in Chapter 21 of the ICD-10 code book. Although the ICD-10 preventive codes are fairly straightforward, preventive coding can still be complicated, of course, in part because of the Affordable Care Act (ACA).
ICD-10 recognizes that the type of vaccine you report with a CPT or HOPES code gives sufficient detail about the type of immunization the patient needed. So rather than having you provide individual diagnosis codes for each vaccine, ICD-10 allows you to report code Z23 for an encounter involving immunization regardless of the type or number of vaccines.
This is especially advantageous when reporting multiple childhood immunizations. Under ICD-10, you simply report code Z23 regardless of how many or what types of vaccines are administered.
For children 29 days old and older, use one of two codes : Z00.121, Encounter for routine child health examination with abnormal findings, or Z00.129, Encounter for routine child health examination without abnormal findings. Routine annual exams for adults are reported similarly to well-child exams, including the requirement to report additional codes to identify abnormal findings.
Z01.411, Encounter for gynecological examination (general) (routine) with abnormal findings, Z01.419, Encounter for gynecological examination (general) (routine) without abnormal findings.
When reporting a gynecological exam, you may report additional codes for screening for human papillomavirus (Z11.51), a screening vaginal Pap smear (Z12.72), or acquired absence of uterus (Z90.71), if applicable. If you provide a screening Pap smear for malignant neoplasm of the cervix outside a gynecological exam, you would report that with code Z12.4.
It is not necessary to report code Z12.4 when the screening takes place as part of a gynecological exam (Z01.411 or Z01.419). Your code selection for a routine examination of the eyes and vision will also depend on whether you have identified any abnormal findings.
Z01.00, Encounter for examination of eyes and vision without abnormal findings, Z01.01, Encounter for examination of eyes and vision with abnormal findings.
Z01.118, Encounter for examination of ears and hearing with other abnormal findings Note that code Z01.110, although it refers to a failed hearing screening, still involves services provided in a preventive context.
Patients dread certain preventive services that require unpleasant preparation, involve substantial expense, or include some level of uncertainty and discomfort. The good news is that you now have more time to prepare for ICD-10 because the implementation date has moved to Oct. 1, 2015.
Like the patient who chooses to undergo screening, a prepared practice may catch problems early and more easily resolve them. Author disclosure: no relevant financial affiliations disclosed.
Services for a young child will assess physical growth (height, weight, head circumference) and developmental milestones such as speech, crawling, and sleeping habits. Anticipatory guidance may include use of car seats and other safety issues, introducing new foods, etc.
An adolescent preventive service may include scoliosis screening, assessment of growth and development, and a review of immunizations. Anticipatory guidance may focus on developing positive health habits and self-care, including discussion of drug, alcohol, and tobacco use, and sexual activity.
A comprehensive preventive visit for an adult female patient will include a gynecologic examination, Pap smear, and breast exam. An adult male’s exam would include an examination of the scrotum, testes, penis, and the prostate for older patients.
Anticipatory guidance may focus on issues of health maintenance, such as alcohol and tobacco use, safe sex practices, nutrition, and exercise. As patient age advances, cholesterol levels, blood sugar, and prostate-specific antigen (PSA) testing may become increasingly relevant.
You also should code for any abnormalities found, regardless of whether the finding requires an additionally reported service. Testing and Problem-Focused Testing Are Separate Per CPT® coding guidelines: If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.
The codes in the preventive medicine services include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. The performance of immunization and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately.
Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. Author’s Note: Although the CPT Assistant article cited predates the ACA, the advice to contact your payers regarding their reporting requirements remains valid.
For more information about Medicare Preventive Medicine Services and Screenings, visit the CMS website. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999.
ICD-10-CM diagnosis codes support medical necessity by identifying the reason for the patient encounter, which may include an acute injury or illness, a chronic health condition, or signs and symptoms (e.g., pain, cough, shortness of breath, etc.) When a patient presents for health screening services without a specific complaint, however, it’s time to call on Codes.
Screening differs from diagnostic examination, in which testing occurs in a patient with signs and symptoms to rule out or confirm a suspected diagnosis. Example 1: A 60-year-old male patient presents to the outpatient radiology department for a lower gastrointestinal (GI) examination.
Ramesh has more than 11 years of experience in the management, medical coding, auditing, and revenue cycle sectors, and in coder and auditor calibration, new training module program creation, with multi specialty expertise in radiology, evaluation and management, and surgery. Note Z codes represent reasons for encounters.
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. (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.