Wiki Z00.00 Primary Diagnosis with office EM.

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hah1678

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Can anyone help me find documentation that I can provide to my providers that we cannot bill a Z00.00 as a primary code with 99201-99215 EM visits? I have our denials but they want something definitive. Thank you!
 
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I would just either give them or have them read the CPT descriptions of 99201-99215. They all state, "Usually, the presenting problem(s)…" These codes are problem focused E/M services. I would then have the providers look at the third paragraph in the "Preventive Medicine Services" section in CPT. Basically, if the patient has no complaint, there is no medical necessity to support a problem-oriented E/M service and either a preventive medicine services code or special evaluation and management services code should be used instead.
 
My providers are performing telehealth services and some of the patient's have no presenting problems or chronic illnesses that can be addressed. Since 99381-99397 cannot be billed via telehealth they are wanting to bill 99201-99215 for these visits with the Z00 code or similar wellness check zcode.. Thank you for the link Sharon it is much appreciated, but when I showed them they said that pertains to a procedure being performed. Does anyone have anything else besides the CPT descriptions? Thanks again!
 
jenniupchurch said:
My providers are performing telehealth services and some of the patient's have no presenting problems or chronic illnesses that can be addressed. Since 99381-99397 cannot be billed via telehealth they are wanting to bill 99201-99215 for these visits with the Z00 code or similar wellness check zcode.. Thank you for the link Sharon it is much appreciated, but when I showed them they said that pertains to a procedure being performed. Does anyone have anything else besides the CPT descriptions? Thanks again!
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I agree with the above responses - 99201-99215 are only for the diagnosis and treatment of problems. If the patients have no problems or chronic illnesses, what service exactly are the providers performing by telehealth?
 
Hi there,
I totally agree with the advise posted above, I just have to prove it to the physicians because they think they should be able to bill these visits with the Z00.00 codes.
 
jenniupchurch said:
My providers are performing telehealth services and some of the patient's have no presenting problems or chronic illnesses that can be addressed. Since 99381-99397 cannot be billed via telehealth they are wanting to bill 99201-99215 for these visits with the Z00 code or similar wellness check zcode.. Thank you for the link Sharon it is much appreciated, but when I showed them they said that pertains to a procedure being performed. Does anyone have anything else besides the CPT descriptions? Thanks again!
Click to expand...


Good heavens, that was just an example of when to use it. But if they have no sign, symptom, problem... I have to echo the above... why are they doing telehealth and what exactly are they doing??
 
Trust me I know. To me the note reads exactly like a physical 99381-99397. There is nothing wrong with the patient. But since you can't bill those codes telehealth they want to bill them as new or established EM. I'm telling them they can't, but they want proof.
 
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