Primary Care Coding Alert

Question: Our provider saw a patient who had not seen a doctor in years and who wanted to establish care. The patient had no complaints, so the provider ordered routine labs without any diagnoses. Is Z00.00 the correct code to use to report this encounter? I’ve been told by a colleague that most insurance companies will deny it, but I can’t find a better code to describe the situation.

Missouri Subscriber

Answer: Z00.00 (Encounter for general adult medical examination without abnormal findings) is the generally accepted code for a physical exam for an adult presenting without a specific complaint or problem when the exam does not reveal any specific complaint or problem. However, there may be a better code for the encounter you describe.

That’s because your provider ordered labs for the patient for some reason, and, per the guidelines for ICD-10 Chapter 21, “a corresponding procedure code must accompany a Z code to describe any procedure performed.” This means the procedure codes for the labs ordered likely are accompanied by other Z codes that more accurately represent the kind of screenings your provider has ordered. Those Z codes are most likely found by turning to the Z13 (Encounter for screening for other diseases and disorders) family of codes, such as Z13.1 (Encounter for screening for diabetes mellitus), Z13.220 (Encounter for screening for lipoid disorders), Z13.81- (Encounter for screening for digestive system disorders), and so on. If one or more of those diagnoses better reflect the reason for the encounter, you may consider reporting them in lieu of Z00.00.

Depending on the patient’s insurance company, either Z00.00 or a code from the Z13 family may result in a claim denial. However, insurance coverage should not dictate the code chosen. The code selected should reflect the reason for the encounter, regardless of subsequent adjudication by the insurance company.