Z01.30 and Z01.31

[Zorrogirl70]

Hello, can someone help me break down this scenario? My employer is requiring coders to add Z01.30 or Z01.31 to every claim that includes a CPT II code for blood pressure measurement in order to meet a state quality metric.

My questions are:

• Should the provider be required to document whether the blood pressure is normal or abnormal in the medical record for the coder to assign these diagnosis codes?
• I do not feel comfortable basing code selection solely on the blood pressure value that is automatically generated in the documentation without explicit provider assessment.
• Additionally, according to coding guidelines, if the blood pressure is abnormal, there should be an additional diagnosis code to capture the abnormal finding.

I would appreciate any guidance or insight on whether this practice is compliant with coding standards.

 

[sls314]

Hello, can someone help me break down this scenario? My employer is requiring coders to add Z01.30 or Z01.31 to every claim that includes a CPT II code for blood pressure measurement in order to meet a state quality metric.

My questions are:

• Should the provider be required to document whether the blood pressure is normal or abnormal in the medical record for the coder to assign these diagnosis codes?
• I do not feel comfortable basing code selection solely on the blood pressure value that is automatically generated in the documentation without explicit provider assessment.
• Additionally, according to coding guidelines, if the blood pressure is abnormal, there should be an additional diagnosis code to capture the abnormal finding.

I would appreciate any guidance or insight on whether this practice is compliant with coding standards.

• I do not feel comfortable basing code selection solely on the blood pressure value that is automatically generated in the documentation without explicit provider assessment.

A coder should not do that. We do not code from lab or blood pressure values. We assign codes based on what the provider has stated about those values.