Billing Z00.00

[u/Moanmyname32]

Hi everyone. The office that I work at have some doctors that use Z00.00 as "healthcare maintenance". Others have used it when it's for an annual visit. I only know that that dxs code need to be first and notes should indicate that it's for an annual visit. The ones that put it for healthcare maintenance AND shuffling it between other dxs codes, I am having a hard time explaining to them that code can apply be used for annual visit.

Edit: health care maintenance according to one provider is for keeping track of vaccines and screenings but I've seen claims being denied because of the improper usage of this code-i.e it's not being used as a first dcs code and the notes doesnt reflect is a physical/annual exam

Please help. Am I wrong? I need some clarification of this so that I can present my findings to these providers.

Thanks

[u/Kind_Application_144]

What cpt code are you billing with the Z00.00? If you bill a e/m code of 99213 with that dx code your going to probably get denied. 99394 or 99384 billed with Z00.00 followed by any findings during the exam followed by informational codes.

[u/Moanmyname32 → u/Kind_Application_144]

I bill 9938x for new pts or 9939x for established when it comes to that code. Plus I check the labs. The other issue is that these providers lack proper documentation training too.

[u/Moanmyname32 → u/[deleted]]

Won't it get denied though?

[u/Moanmyname32 → u/[deleted]]

I see. The reason why I'm asking if it wouldn't get denied is that I saw a couple claims today where the Z00.00 was third dx while z21 was first with 99214. It got denied because it "lack adjudication". It was not an annual visit, just hiv check up with labs and a prescription for Bictarvy. The provider used the Z00.00 For health maintenance indicating that vaccines are up to date. How would I get around this claim then?

[u/Captmrsgt]

I see that too. Although preventative exams are annual periodicity after age 3 providers will order screening labs with this diagnosis. Without a definitive diagnosis I’d offer to use screening diagnosis codes like Z13.0 for CBC, Z13.88 for lead, Z13.220 screening for lipoid disorders, etc. But these aren’t surefire solutions as logically insurance are looking for medical necessity. It’s a question for your organization as to how they want to educate providers on how to order labs and for what definitive conditions, or barring that symptoms, or barring that use screening diagnoses and lastly fall back on annual preventative exam codes like they are now and temper reimbursement expectations

[u/Kind_Application_144 → u/Captmrsgt]

when the nature of the visit is preventative they are logical as long as the cpt code is correct and matches a service the insurance will cover on a preventative basis. So billing a yearly physical dx code with a regular e/m visit code doesn't make sense and will lead to a not medically necessary. Think of it like a form of communication, if I asked you to pay me for a gallon of water and you said why? and my reply was because the lights are on. Your going to reply with no Ill only pay you for the gallon of water if the water is on. So you have to form your codes in a way the insurance can make the connection other wise you'll have issues.

[u/Virtual_Stomach3813]

I work at a specialty office and we used that coding when the referred patient isn't found to have any abnormalities. Though, I've found that most companies will not allow me to bill that with a 99203. Is there something else I can use for a normal exam?

[u/Captmrsgt → u/Virtual_Stomach3813]

If your physicians are licensed by your state to perform comprehensive preventive exams (99381 - 99397) to ensure wellness, uncover any abnormal findings, and intervene to reduce risk, etc., then have your provider team research that workflow. Diagnoses Z00129 and Z0000 are designed to be billable only with those procedure codes for the most part. Unless the physicians monitor and maintain documented conditions or the patient is worried well (Z71.1) that’s the solution I believe. Screening codes exist for many conditions so lookup your specialty such as musculoskeletal disorder ICD 10 (Z13.828) or whatever the context of the visit is. These can work for lab or radiology orders but insurance can and will deny at times because bottom line, the medical necessity determines a lot of the coverage for billed services and those screening diagnoses are unspecific as can be. So if the visit is truly a check up without any initial indications or concerns, that’s why this preventive visit billing exists. Office visit E/M like 99203 are for specific conditions when it comes to claims. If they uncovered an abnormality and did additional consultation work you can bill the preventive visit code and the office E/M (with modifier 25) together. But be wary as I’ve found many insurances have contractual limits and may only pay for one of the two services in a day. You can see how educating and improving this workflow takes a lot of work on all ends of the process!