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.
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Tag Archives: Z01.419
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 …