Wiki Encounter code Z76.0

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ahuffine

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CMS denied 99213 that was billed with Z76.0, R21. (Pt also had a blood draw done and that was billed with L08.0, R21.) The denial states "This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam". Can anyone tell us if the OV should not have been billed with the Z code at all or just not with a blood draw? The way I am reading the ICD-10 guidelines is this particular code is considered a Misc and not Routine/administrative. Thanks! :confused:
 
Code Z76.0 is reported for an encounter for repeat prescription only. The additional codes of R21 and for the labs, L08.0 indicate this encounter was not only for repeat prescription. It should be noted also that while the patient's chief reason for an appointment may be to receive a repeat prescription, physicians must evaluate the related condition and determine if a repeat prescription is appropriate so the physician's diagnosis is typically the condition and not the patient's request for a refill.

Also, if the physician diagnosed pyoderma, the rash is likely integral to that condition and not separately reported.

I hope that helps.
 
Redeterminations

It appears that along with the ICD10 code set, CMS has added a clinical edit to the claim editing tool they use and they are denying office visits that report both a preventive and diagnostic code, for the reason you stated.

Problem is patients come in all the time for preventive and you end up addressing a symptom and you should be able to report this for reimbursement. I am using the CER and/or Redetermination feature from CSnap in an effort to explain to CMS why the claim should be medically necessary and payable.

Best of luck. It's going to be a bumpy ride.
 
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