My original question was regarding ICD codes and when it is appropriate to code chronic conditions or additional diagnoses with well checks.
The debate has been whether or not you can code a well check code (Z00-) with a diagnosis code (and attach both to the well visit 99395). The ICD 10 book states an excludes 1 note under Z00- saying, "encounter for examination of sign or symptom- code to sign or symptom." An adult or child that presents to his/her primary care physician for a well-check is not presenting for an encounter for examination of sign or symptom. If the patient happens to bring up a complaint during the exam, then this complaint should be treated as an additional e/m with the well visit.
Of course, not all physicians will document enough to warrant an e/m. The coding guidelines state that chronic conditions or additional diagnoses found upon examination of a patient during a routine health exam can be coded as secondary diagnoses.
Chapter 21 of the ICD 10 book states that
nonspecific abnormal findings are coded using R70-R94. The Z00- codes do not use the term "nonspecific" (such as Z00.01 encounter for general adult medical examination with abnormal findings), so, any other abnormal findings such as a specific diagnosis like headache can be coded in addition to the Z00.01 code.
Of course, this is my interpretation of the rules and I realize not everyone agrees. I appreciate all of the feedback and would love to hear more!!!!! I wish this was more clear.
I've been re-reading the ICD-10 book over this for the past couple of days, along with the other coders in my office...this has been quite confusing!
I work in pediatrics, so I submitted my concern to the AAP and they provided me documents stating that yes, you can code chronic conditions and diangoses found upon examination of the patient in addition to the well check Z00.121.