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Click here for more sample CPC practice exam questions and answers with full rationale

Z00.00 vs Z01.419

We are getting denials from Wellmark on yearly preventative/physical visits in which PCP performs physical with review of chronic conditions along with Pap. When using 99396 (for example) and Z01.419, they are denying asking for more specific diagnosis. Is it the Z00.00 they want and when do you use either Z00.00 or the Z01.419? Thank you.

Medical Billing and Coding Forum

Z00.00, Z00.01, Z00.419 when billed with sick OV

Hi, everyone!

I’m seeing a lot of claims where my providers are seeing patients for a CPE or a Well Woman Annual exam, and they’re using 99201-99215 along with Z00.00, Z00.01 and Z00.419 as the primary dx. The payers are paying the claims as they are coded, for the most part. I’m wondering if this is allowable, and my only gripe is the money we’re losing out on by not coding 99385-99397? Is there documentation I can show my providers that says that this is not allowed?

Thanks!

Medical Billing and Coding Forum

Z00.00 confusion

Hello! I need some help with Dx code Z00.00 due to a recent denial. Should this Dx code ONLY be used when patient is in for a preventive exam (medicare wellness or annual physical)? Is it correct that this code should never be used if the provider is also listing chronic or acute conditions to the office visit?

What if the provider decides to order screening labs during a regular office visit (not at an annual physical) and the patient doesn’t have a diagnosis to associate with those screening labs?

I really appreciate any input! This is a confusing one for me. Thank you!!!;)

Medical Billing and Coding Forum

Z00.00 for every follow up

Hi,

I work at a clinic and there are a couple of providers that, during a follow-up appointment, will review that vaccines, basic labs and screenings are up to date, and document it similar to this:

Adult health examination – Basic labs: 11/6/17
Colonoscopy: 2/2014, 2 polyps and mild diverticulosis; repeat in 2019
Vaccinations:

Tdap: 2013

Pneumovax: 3/2014

Flu: 10/13/17

HepB, C, and HIV screening: neg

However, they consistently choose Z00.00 as the diagnosis for this part of the visit but I know should only be coded to a Preventive CPT code. Does anyone have any advice as to what other DX codes I can use? Or would this be okay if the problem DXs are listed first and then Z00.00 listed after?

Medical Billing and Coding Forum

Ordering labs with Z00.00

Physicians are used to order labs CBC, CMP, TSH, Lipids for asymptomatic Medicare patients with Z00.00. "Z00.00" is not a valid dx for ordering labs on pts. So my question is: Can the physician order Cbc, Cmp, Tsh, Lipids as part of AWV and what diagnosis codes should he use ? What exact labs can he order during Wellness visit? Thank you!

Medical Billing and Coding Forum

Z01.419 or Z00.00

We are having a discussion at my work place between coders.

If a patient is seen by a GYN provider and he does a complete (head to toe) exam would the correct ICD 10 code be Z00.00 (general adult exam) or Z01.419 (GYN exam).

I would think if the provider is only doing a breast exam and pelvic with or without it would be appropriate to use the Z01.419. If they are performing a head to toe then the Z00.00 would be appropriate .

I appreciate any feedback …

Medical Billing and Coding Forum

Z00.00 for a Pap and HPV

I do diagnostic coding for my hospital’s lab/x-ray/path depts…outpatient facility coding. I have many questions. I’ll start with this one first.

Often the order will come in with a DX of Z00.00 adult general screening exam for a woman whose tests ordered are Pap and HPV.

I must enter an Admit Dx (only one is allowed), then a Primary and any number of secondaries.

For the above is this correct?

Admit Dx: Z00.00 Primary: Z00.00 Secondary: Z12.4 and Z11.51

How do I handle the EDIT that pops up stating I can’t code Z12.4 with Z11.51?

I’m dying for insight on this scenario.

Thanks so much.

Medical Billing and Coding | AAPC Forum