Aida Posted Tue 24th of March, 2015 09:54:47 AM
Presently, we are doing two notes for when a patient comes in for a V20.2 if abnormal findings are found.
My questions is when ICD-10, Z00.121
Encounter for routine child health examination with abnormal findings
code to identify abnormal findings
Will we have to code it on the same note, or will we be able to do the additional note to document the abnormal findings.
Then bill the two notes like we are currently doing.
SuperCoder Answered Wed 25th of March, 2015 03:35:46 AM
We are not very clear what are you suggesting by "two notes", however Z00.121 is the correct I10 code which you should use. Use an additional code to identify the "abnormal findings" as the secondary code to Z00.121. Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94. Specific abnormal findings may have another code. However both I10 codes (Z00.121 + abnormal finding code) needs to be billed in same claim.
SuperCoder Answered Wed 25th of March, 2015 07:13:22 AM
Aida Posted Wed 25th of March, 2015 16:05:36 PM
What I mean is that currently when we bill a physical using the DX: V20.2 and abnormal finding are found. We will open another note and document the abnormal finding and bill those services separately with modifier 25.
With ICD-10, when doing a physical with abnormal finding we will use the DX: Z00.121 Encounter for routine child health examination with abnormal findings
code to identify abnormal findings....plus we would apply the DX for the abnormal findings...correct...
my question: will we be able to bill the abnormal findings in another note with the modifier 25.
SuperCoder Answered Thu 26th of March, 2015 06:38:32 AM
When ICD-9 is replaced by ICD-10, you are going to be using two routine child health visit codes instead of one. Knowing the definition of “abnormal findings” is the key to choosing the right code.
With the release of ICD-10, you will replace ICD-9 V20.2 (Routine infant or child health check) with two ICD-10 codes: Z00.129 (Encounter for routine child health examination without abnormal findings) and Z00.121 (Encounter for routine child health examination with abnormal findings).
The primary difference between the two child health exam codes is that one is used when the exam includes an abnormal finding and the other is an exam without an abnormal finding. Stedman’s Medical Dictionary defines “abnormal” as differing in any way from the usual state, structure, condition, or rule.
You will attach the Z00.129 to the E/M service when there is no abnormal finding. If there is an abnormal finding, you will attach the Z00.121. You will need another code with Z00.121 to identify the abnormal findings.
Tip: CMS explains in an August 20, 2013, ICD-10 training, that “Should a general medical examination result in an abnormal finding, the code for general medical examination with abnormal finding should be assigned as the first-listed diagnosis. A secondary code for the abnormal finding should also be coded.” To learn more, take a look at www.cms.org/icd-10/training.
“Abnormal findings” does not refer to blood tests, biopsies, or tests that go to pathology. Frequently, these significant abnormal findings will support a separate, problem-oriented E/M visit billed with a modifier 25 at the time of a preventive medicine visit, rather than the use of the Z00.121 diagnosis code.
So yes, when the "abnormal finding" requires a significant enough service for a more severe Dx condition, bill a problem oriented visit separately with mod. 25 with Dx code for the actual "problems" for which this problem oriented EM service is billed. Do not go with Z00.121 then.