These Z00 codes are causing a great deal of confusion and I hope there will be further guidance. I'm not sure I agree that a preventive service and an office visit service cannot be billed on the same day or that the patient would need to come back on another date. This certainly would be onerous to the patient.
If the physician appropriately documents the elements of the preventive service and then
seperately documents an office visit for the work-up of an "Oh, by the way, doc, while I'm here, I've had this knee pain for 2 weeks" type of sign or symptom, this, to me, should not fall under an Excludes1 situation.
Excludes1 notes apply to
diagnosis codes, not CPT codes. You would
not be able to bill a preventive service CPT with Z00.00 plus an additional code for the knee pain; but you should be able to bill:
- 99396 linked only to Z00.00
- 99213-25 linked only to the knee pain diagnosis
That's my opinion anyway but am willing to live and learn if more offical guidance comes out.
My other point of confusion is for patient's coming in for their annual physical, without compliants, but who do have a known stable chronic condition (such as hypertension). This condition is well controlled on meds. During the course of the preventive service the hypertension is addressed but since it is stable no changes to medications are made. This would be considered inclusive to the preventive service; but I'm wondering if the known, stable condition is still considered an 'abnormal finding' for as long as the patient has the hypertension and therefore the preventive service could go always go out as 99396 with Z00.01 and I10.