Tina Posted Mon 26th of February, 2018 10:28:09 AM
I am trying to understand the appropriate way to report hearing and vision screens and normal VS abnormal Well visits. What are the ICD10 codes we suppose to use or what codes are other practices using for ICD 10 for Hearing and vision screen done at well visits? Normal and abnormal.
According to Bright Futures, we should be using the following:
Z00.121 – Routing child health exam with abnormal findings
Z00.129 – Routine Child health exam without abnormal findings
However, according to the coding seminar we had with Dr. Tuck, we were told to use Z01.00 and Z01.01 (examination of eyes and vision with and without abnormal findings) if not getting paid by insurance companies. Bright Futures states we cannot use these codes when a vision and hearing screen is done at a well visit. We can only use them when the screenings are done alone.
Just to complicate things further, if we have an abnormal finding on the hearing or vision screen or if the child fails the screening, do we need to report or code the well visit E & M code itself with the abnormal finding ICD 10 code? For example,
A patient was seen for an 11-year-old well visit. The patient is completely healthy with no issues. The patient failed their vision screen. Do we code 99393 using the Z00.121 and report his 11-year well check with abnormal findings because he failed the vision screen, or, do we code 99393 with Z00.129 because he is healthy with no abnormal findings and only code 99173 with Z00.121 since he failed the screen?
SuperCoder Answered Tue 27th of February, 2018 06:05:01 AM
- If an illness or abnormality is encountered, or a pre-existing problem is addressed, in the process of performing the preventive medicine service, and if the illness, abnormality, or problem is significant enough to require additional work to perform the key components of a problem-oriented evaluation and management (E/ M) service (history, physical examination, medical decision-making, or a combination of those), the appropriate of code or other outpatient service code (99201–99215) should be reported in addition to the preventive medicine service code. Modifier 25 should be appended to the of code or other outpatient service code to indicate that a significant, separately identifiable E/ M service was provided by the same physician on the same day as the preventive medicine service.
- An insignificant or trivial illness, abnormality, or problem encountered in the process of performing the preventive medicine service that does not require additional work and performance of the key components of a problem-oriented E/ M service should not be reported. The comprehensive nature of the preventive medicine service codes reacts an age- and gender-appropriate history and physical examination and is not synonymous with the comprehensive examination required for some other E/ M codes (e.g., 99204, 99205, 99215).
- Immunizations and ancillary studies involving laboratory, radiology, or other procedures, or screening tests (e.g., vision, developmental, and hearing screening) identified with a specific CPT® code, are reported separately from the preventive medicine service code.
For example, A patient was seen for an 11-year-old well visit. The patient is completely healthy with no issues. The patient failed their vision screen. Do we code 99393 using the Z00.121 and report his 11-year well check with abnormal findings because he failed the vision screen, or, do we code 99393 with Z00.129 because he is healthy with no abnormal findings and only code 99173 with Z00.121 since he failed the screen? If the patient found with abnormal finding during preventive visit e.g. 99393 append ICD 10 Z00.121 and in the next line bill for special screening exam CPT or E&M outpatient code as per the documentation with appropriate diagnosis or finding of special exam ICD 10 code e.g bill 99173 with Z01.01. PLease find undermentioned link for more information.
Hope this helps!