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Be accurate, thorough when coding patient visits
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LAS VEGAS — Medical professionals should not shy away from using more than one correct Z code to describe a patient visit, according to a presentation at the Cardiometabolic Risk Summit.
“This is not about us trying to game the system at all,” Timothy S. Harlan, MD, assistant dean for clinical services at Tulane University School of Medicine in New Orleans, said. “This is about us getting paid for the hard work we do.”
The panelists said providers should give as much information as possible, noting some scenarios may require up to a dozen codes.
“I do medical malpractice cases where lawyers will tear apart your chart and find the most innocuous little thing you didn’t do and say that’s why this person had a bad outcome,” Ben Taylor, PhD, PA-C, clinical faculty for the physician assistant program at Georgia Regents University, said.
Providers should use the reason for a patient’s visit as the main term and outline the determination in the numbers that follow, Taylor said. For example, a problem related to a patient’s lifestyle would get Z72. If the reason is lack of exercise, the code becomes Z72.3.
“There is a code for everything … everything,” Taylor said.
Vaccinations
Even if a patient refuses a vaccination, it should be noted - Z28.82, Taylor and Harlan said.
Z Codes can be found in Chapter 21 of ICD-10-CM. A free app —ICD Coding Consult 2010-2017 — can help providers and their staff, Taylor said.
Other Codes
Taylor also provided other examples where Z codes may not be as apparent:
•Z00 covers “encounter for general adult medical exam without abnormal findings”;
•Z71 covers “persons encountering health care services for other counseling and medical advice not elsewhere classified;
•Z80 – Z99 covers “persons with potential health hazards related to family and personal history and certain conditions influencing health status”; and
•Z91 covers “personal history of risk factors not elsewhere classified”.
Obesity
CPT 99401 and CPT 99402 can be used for obesity counseling, as can HCPCS G0447, which sometimes be submitted instead of Z codes, Harlan said.
“The bad news is that it doesn’t really reimburse very well,” Harlan said. “The good news is that I think this heightened symptom awareness among CMS and the insurers say that if you document this correctly, and you’re billing for level 5 … and if you document this pretty well with the lifestyle counseling, … they’re going to reimburse you.”
– by Janel Miller
Disclosures: Harlan reports a publisher role with Harlan Brothers Productions, LLC. Taylor reports no relevant financial disclosures.
Reference:
Harland T. and Taylor B. Billing and coding for diet and exercise counseling. Presented at: Cardiometabolic Risk Summit Fall Conference; Oct. 14-16, 2016; Las Vegas.
Additional Reading:
https://www.medicare.gov/coverage/obesity-screening-and-counseling.html Accessed Oct. 20, 2016.