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    Preventive  and  E/M coding: What diagnoses go where?


    • When a new patient presents for problem oriented Evaluation and Management service in conjunction with a Preventive Service, the problem oriented visit may be billed with an established patient Evaluation and Management code.

    The problem oriented portion of the visit must be significant and separate identifiable. A 25 modifier is required on the problem oriented visit.

    In a scenario where an E/M code is billed in addition to the preventive service, you should associate Z00.01 with the preventive care code, and the medical diagnosis(es) addressed at the visit with the E/M code. If you utilize Z00.00 in this situation, you more than likely will receive a denial for the E/M code.

    A:  Transmittal 1719 , dated August 31, 2001, (that hasn’t been superseded since), reads, “All claims for pre-operative medical examination and pre-operative diagnostic tests (i.e., pre-operative medical evaluations) must be accompanied by the appropriate ICD-10 code for pre-operative examination. Additional appropriate ICD-10 codes for the condition(s) that prompted surgery and for conditions that prompted the pre-operative medical evaluation (if any) should also be documented on the claim. Other diagnoses and conditions affecting the patient may also be documented on the claim, if appropriate.”

    So you should list the screening diagnoses first, and then any diagnosis(es) for condition(s) found. In this scenario, you should bill  Z13.6  (Encounter for screening for cardiovascular disorders), and the second diagnosis would be
     I45.10  (Unspecified right bundle-branch block). 


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