Abnormal Findings

[wrightju1]

Has anyone seen any guidance on how Z00.121, Encoutner for routine...with abnormal findings will be handled if the encounter is in conjunction with a seperate E/M with 25 mod for a chief complaint? Is the seperate service dx going to count as an abnormal finding for the routine health exam?

For example, a parent brings a child for their check up and coincidentally the kid has an eye irritation. A fully supported E/M is done for conjunctivitis, as well as the regular check up that discovers no other health problems.

Would the conjunctivitis be considered an abnormal finding from the health exam encounter?

 

[mitchellde]

Has anyone seen any guidance on how Z00.121, Encoutner for routine...with abnormal findings will be handled if the encounter is in conjunction with a seperate E/M with 25 mod for a chief complaint? Is the seperate service dx going to count as an abnormal finding for the routine health exam?

For example, a parent brings a child for their check up and coincidentally the kid has an eye irritation. A fully supported E/M is done for conjunctivitis, as well as the regular check up that discovers no other health problems.

Would the conjunctivitis be considered an abnormal finding from the health exam encounter?

If the patient presents with an obvious eye issue or is complaining of one then this is not an abnormal finding, it is a presenting symptom, which if you read the exclude 1 exclusion cannot be coded here. If the patient presents with symptoms or complaints the exclude 1 note instructs to code the encounter to the symptoms, meaning you will need to defer the preventive.
The choice for with abnormal finding would be used if there is no chief complaint or presenting symptom, but rather an issue discovered by the provider in the course of the preventive exam.
The affordable care act prevents billing a separate E&M when the reason for the visit us preventive. So you would not have a separate E&M when it us an abnormal finding as the reason for the encounter is still preventive. I suggest dropping the preventive E&M and use a visit level that can be met by the entire visit document and append the 33 modifier.

 

[wrightju1]

The affordable care act prevents billing a separate E&M when the reason for the visit us preventive. So you would not have a separate E&M when it us an abnormal finding as the reason for the encounter is still preventive. I suggest dropping the preventive E&M and use a visit level that can be met by the entire visit document and append the 33 modifier.

Could you please provide the link for this information on the affordable care act referencing seperate E&M? I don't believe I've heard anything about this.

 

[wrightju1]

If the patient presents with an obvious eye issue or is complaining of one then this is not an abnormal finding, it is a presenting symptom, which if you read the exclude 1 exclusion cannot be coded here. If the patient presents with symptoms or complaints the exclude 1 note instructs to code the encounter to the symptoms, meaning you will need to defer the preventive.

The Excludes 1 for this code is "examinations related to pregnancy and reproduction". I am not following your logic for not coding the preventive that the patient came in for and the seperate dx and treatment for the conjunctivitis. Help me understand where you're coming from.

 

[mitchellde]

Could you please provide the link for this information on the affordable care act referencing seperate E&M? I don't believe I've heard anything about this.

Here is the excerpt from the affordable care act:
The Patient Protection and Affordable Care Act of 2010 requires all health insurance plans to begin covering preventative services and immunizations without any cost sharing requirements. Cost sharing requirement would mean co-pays, coinsurance, or deductible. If the preventative services are part of an office visit then the office visit may not have cost sharing if the primary reason for the visit is the preventative service. If the office visit and preventative service are billed separately and the primary reason for the office visit was not the preventative service then cost sharing is permitted for the office visit.
If the patient presents with symtoms or complaints then the primary reason for the encounter will n ot be preventive and cost sharing for the office ebcounter is permitted. if the patient has no concerns or complaints then you cannot bill a separate office encounter as there will be a co pay.
The ICD-10 CM codes will not allow symptoms and complaints to be included with a preventive, see the exclude 1 note for this. You can however have abnormal findings disvovered by the provider, but the primary reason for the encounter is still preventive.

 

[wrightju1]

The ICD-10 CM codes will not allow symptoms and complaints to be included with a preventive, see the exclude 1 note for this. You can however have abnormal findings disvovered by the provider, but the primary reason for the encounter is still preventive.

I just can't find the exclude 1 you're talking about. Where exactly can I find it in the draft book? My docs are gonna wanna see this in print.

 

[wrightju1]

Can you please tell me what section of the ACA this excerpt is from? I'm not aruguing, I know it's hard to interpret a tone in print. But I would like to read ore on this subject. And I will need to present this information and site my source to my doctors. I'm just not able to nail down the specific section.

I can see how one can't turn a preventive appointment into an office visit, and vise versa. However, it leaves me with more questions. What if the provider performs a procedure in conjunction with the preventive visit? Is it only E/M services that cannot be billed along with a preventive service? Would this also apply to addition time spent on counseling codes? I just want to go to the source information we are talking about and start building from there.

I am also not finding the Excludes 1 you were talking about. The only Excluses 1 I found related to pregnancy and/or age of patient.

Come one Ms. Missouri, show me!

 

[mitchellde]

I just can't find the exclude 1 you're talking about. Where exactly can I find it in the draft book? My docs are gonna wanna see this in print.

The category description says it also:
Z00- Encounter for general examination without complaint,
suspected or reported diagnosis
It states without complaint. The exclude 1 is under the Z00.0 subcategory. I see it is not under the Z00.1 subcategory but the category description goes with the subcategory.
The exclude 1 note is also under the Z01 category.
Alo the wording with abnormal finding indicates this is a finding by the provider not a presenting problem.

 

[wrightju1]

Ah, I see what you're saying now. Makes perfect sense. Thanks!

So, that leads me to another question. Are only newly discovered problems considered abnormal findings?

 

[mitchellde]

Ah, I see what you're saying now. Makes perfect sense. Thanks!

So, that leads me to another question. Are only newly discovered problems considered abnormal findings?

I would not think so. If a patient is diabetic and not really compliant with checking their levels and diet, they may have a high blood sugar and be unaware of it until the office visit for the annual exam and this is discovered in the office. I had friends in school that were like this. I like to say that a lot of people have felt wretched for so long that they are unaware of what normal healthy is suppose to be.

 

[wrightju1]

I have found a link that has helped me answer my question on billing preventive along with office visits. http://www.hhs.gov/healthcare/rights/preventive-care/index.html

Under the heading Some Importand Details it talks about Office visit fees:
"...or if your doctor bills you for the preventive services separately from the office visit." I take that as continuing what we do now using the 25 modifier. But it doesn't lead me to believe that you can only do one and not both. And I haven't been able to find anything in the ACA that says no way can you have an office visit in conjunction with the preventive visit.

So, with abnormalities would be, as you said, blood sugars not under control. But it would not mean an additional dx that is falling under a seperate E/M service.

Thanks so much for sorting it out with me!

 

[ccardella]

Has anyone seen any guidance on how Z00.121, Encoutner for routine...with abnormal findings will be handled if the encounter is in conjunction with a seperate E/M with 25 mod for a chief complaint? Is the seperate service dx going to count as an abnormal finding for the routine health exam?

For example, a parent brings a child for their check up and coincidentally the kid has an eye irritation. A fully supported E/M is done for conjunctivitis, as well as the regular check up that discovers no other health problems.

Would the conjunctivitis be considered an abnormal finding from the health exam encounter?

I work for a large physician network and I have been asked this question many times so I thought I would share my reply with you.

The code Z00.01 (adult routine abnormal findings) or Z00.129 (child routine abnormal findings) should be assigned when, during the course of the exam, there is an abnormal finding. For example, in your documentation for the exam if you have: Skin/Hair/Nails: erythematous rash behind ears no itching, no bleeding, Ear/hearing: normal, Eyes.vision: normal, etc. anytime you document a finding outside of ?normal?. In this example, due to the rash, you would code Z00.01 and then code the rash L08.9. The patient could have known of the rash or not know it is there the finding directs the code, provided that this visit was scheduled preventatively and not because of the rash complaint. For the patient with known medical conditions that are stable you would not use the code because the abnormal findings did not occur at this exam but a previous one which resulted in the diagnosis. If they have a known condition that is not stable, meaning you have an abnormal finding for that condition in this exam then, yes, code with abnormal findings.

Another way to consider it is to ask ?what type of data will this code give us?? . It is most likely to be used to assess the percentage of preventative visits that result in findings in asymptomatic patients who would likely not have known about a condition had they not had their physical. Again, directing you toward only reporting this code when abnormalities are found during the exam that did not or likely would not have prompted the patient to visit.

I hope this helps you!

-Tina Cardella, CPC