Wiki Resolved Otitis Media

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tina49ers80

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How are you billing the diagnosis for Otitis Media - Resolved? The patient has no other symptoms to code. The only ICD10 code that seems appropriate is Z09, however insurance companies are denying the office visit when that code is the only one used. Any suggestions?
 
tina49ers80 said:
How are you billing the diagnosis for Otitis Media - Resolved? The patient has no other symptoms to code. The only ICD10 code that seems appropriate is Z09, however insurance companies are denying the office visit when that code is the only one used. Any suggestions?
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What about leading with a follow up Z code and then the OM? Z09 = Encounter for follow up exam after completed treatment for conditions other than malignant neoplasm.

Just a thought. Good luck :)
 
ehanna said:
What about leading with a follow up Z code and then the OM? Z09 = Encounter for follow up exam after completed treatment for conditions other than malignant neoplasm.

Just a thought. Good luck :)
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Or leading with the OM and then the follow up Z code :)
 
Z09 is correct and you would not code for a condition that no longer exists. The question is was this a follow up exam or was it an exam for otitis media? If the patient had otitis media and returned for a recheck then it was not known to have resolved at the time of the encounter so code only the Otitis media. If however it was known to have resolved and this is a follow up visit to be sure there are no issues then the Z09 is correct. Coding clinics have visited this issue many times and have applied this logic for infection recheck encounters.
 
Thank you both for this information. The visit is for a recheck/follow up and it has been determined that the ear infection is no longer present. My thoughts were to use both the ICD10 code for OM & the Z09, which would clarify that it has now resolved. But, since the OM has resolved that diagnosis really shouldn't be coded. Not sure why the insurance companies will not pay for the visit with just the Z09. Thank you again!!
 
mitchellde said:
Z09 is correct and you would not code for a condition that no longer exists. The question is was this a follow up exam or was it an exam for otitis media? If the patient had otitis media and returned for a recheck then it was not known to have resolved at the time of the encounter so code only the Otitis media. If however it was known to have resolved and this is a follow up visit to be sure there are no issues then the Z09 is correct. Coding clinics have visited this issue many times and have applied this logic for infection recheck encounters.
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thank you for this - very helpful!
 
Question what if this wasn't a follow up visit? Patient scheduled visit for back pain but provider states in his HPI that patient had back pain but took medication before coming to office and no longer has pain it has resolved. Would you code the back pain then?
 
I would code back pain. Sometimes by the time patient is seen, the condition is better but they still presented for evaluation of it. Sometimes, too, the pain isn't there that particular day but it may be an ongoing/intermittent issue for which the patient wanted to see a provider.
 
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