CAN DX Z80.812 (FOR PRE-OP LAB EXAM) STAND ALONE? IF NOT IS Z11.52 A GOOD CODE TO ADD TO IT?
Z11.59 is an incorrect code for a COVID test in any case.I am a CPC but I work insurance claims denials. We have hundreds of claims denied because the coders are assigning Z11.59 to pre-procedure covid testing, because the physician's order says "special screening exam for viral disease" or "screening for viral disease." We are able to see in the chart that the patient had a procedure 1-3 days following the covid test so we know that it's a pre-px text, but our coders are saying they can't or won't change it to Z01.81* because the physician did not state on the order that it is a pre-px test. They are asking me to write all of these off, but I would like to get clarification if it is compliant to use the Z01.81* dx code, or if we have to use Z11.59 due to the physician's statement on the order.
The 'medical record', for diagnosis coding purposes, is the documentation by the provider - only a provider can make a diagnosis. So you can code from the reason for the test that the provider gave on the order, or you can code from the documentation in the provider's notes if that gives the reason for the test as being a pre-procedural exam. You can't assume that is the reason just from seeing that the patient had a procedure done. So yes, I agree that some provider education is needed here if the intent of the test was in fact pre-procedural but the providers are just calling it a screening.Thank you Thomas for your quick reply. I do want to clarify, because I am getting so much push back from our coders, when you say "the medical record", are you saying the actual order for the covid test, or the patient's chart? We can show in the chart that the test is followed by a procedure in 1-3 days. The actual order itself, however, gives "screening for viral disease." If the order needs to indicate "preprocedural covid test" then we need to educate the providers to make that change.
Thank you so much! That has been my position, that Z11.59 is inappropriate, regardless. I am forwarding this on to management to push for having the dx changed to Z20.828, and educating the providers going forward.The 'medical record', for diagnosis coding purposes, is the documentation by the provider - only a provider can make a diagnosis. So you can code from the reason for the test that the provider gave on the order, or you can code from the documentation in the provider's notes if that gives the reason for the test as being a pre-procedural exam. You can't assume that is the reason just from seeing that the patient had a procedure done. So yes, I agree that some provider education is needed here if the intent of the test was in fact pre-procedural but the providers are just calling it a screening.
However, I still would argue that your coders are incorrectly using Z11.59 based on the guidelines that have been issued. This is an exceptional situation and instructions are that a screening test for the COVID disease is to be coded as Z20.82- for the duration of the pandemic. Payers are aware of these guidelines and have likely programmed their claims systems to recognize Z20.828 and Z20.828 but not Z11.59.