Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Z01.411 vs Z01.419

Marie Posted Thu 21st of January, 2016 13:37:19 PM

Is there a general rule for with or without abnormal findings on a WWE?
We would like to tell our doctors code with abnormal findings if this criteria is met and without abnormal findings if this criteria is met.
It is so confusing. Is there any documentation we can print for them other than ICD 10 guidelines?

Marie Posted Thu 21st of January, 2016 13:41:34 PM

When we are charging out OB patients for non global care, for example visits Aug thru Sept and then Oct thru January, we divide these into ICD 9 and ICD 10 which breaks up the 59425 and 59426. Is this correct billing? Also when we do this, of course the trimesters are different in ICD 10. Do we use two codes if there are two trimesters involved and if for some reason it in weeks, not trimester, do we put all the Z3A codes?

SuperCoder Answered Fri 22nd of January, 2016 08:26:26 AM

In ICD-10 there are two codes Z01.411 "Encounter for gynecological examination (general) (routine) with abnormal findings" and Z01.419 "Encounter for gynecological examination (general) (routine) without abnormal findings". You must apply codes for the conditions or circumstances known at the time you are billing, so, if you don't yet have the result, it is appropriate to code for a screening without abnormal results. If you can wait till the lab turns these around then apply the code as per the result.
The Official Guidelines for Chapter 21 for routine and administrative exams state that, "Some of the codes for routine health examinations distinguish between "with" and "without" abnormal findings. Code assignment depends on the information that is known at the time the encounter is being coded. For example, if no abnormal findings were found during the examination, but the encounter is being coded before test results are back, it is acceptable to assign the code for "without abnormal findings." So per these guidelines you would not need to wait for test results to come back to code appropriately for the encounter.
Answer to the second part of your question:
As described by ACOG and the AMA, the antepartum care codes 59425 and 59426 should be reported as described below:
A single claim submission of CPT code 59425 or 59426 for the antepartum care only, excluding the confirmatory visit that may be reported and separately reimbursed when the antepartum record has not been initiated. The units reported should be one. ·The dates reported should be the range of time covered. For example, if the patient had a total of 4-6 antepartum visits then the physician and/or other health care professional should report CPT code 59425 with the "from and to" dates for which the services occurred.
You would bill 59425 because of the five visits. One to three visits are billed as individual office visits; four to six is 59425 and seven or more are billed as 59426.
You have to break the codes up since the care is no global. You should bill the visits when you bill the delivery. If you are using 59425 or 59426, the use the last office visit date. Occasionally, an insurance carrier will want to know the span of dates for the visits.

At the very beginning of ICD-10-CM’s Chapter 15 Pregnancy, Childbirth, and the Puerperium (O00-O9A) is a notation applicable to every code in this chapter:
Use additional code from category Z3A (weeks of gestation) to identify the specific week of the pregnancy.

Related Topics