ICD-10 Simplifies Preventive Care Coding, Sort Of
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FPM's ICD-10 coding series continues with a look at how to code immunizations, routine health exams, and common preventive screenings.
Fam Pract Manag. 2014 Jul-Aug;21(4):OA1-OA4.
Author disclosure: no relevant financial affiliations disclosed.
You have no doubt heard about the eight-fold increase in diagnosis codes included in the transition from ICD-9 to ICD-10, but that is not the whole story. You'll be relieved to know that, for some encounters and services, ICD-10 offers fewer or the same number of codes. Codes related to preventive services are examples of this.
This article will focus on how to select ICD-10 codes for immunizations, routine health exams, and common preventive screenings. These are Z codes found in Chapter 21 of the ICD-10 code book.
Although the ICD-10 preventive codes are fairly straightforward, preventive coding can still be complicated, of course, in part because of the Affordable Care Act (ACA). To obtain insurance payments for preventive services covered under the ACA, you must properly code the combination of CPT/HCPCS and ICD-10 codes. For help with that, see “Modifier 33 and more.”
MODIFIER 33 AND MORE
Properly coding the combination of CPT/HCPCS and ICD-10 codes is critical to getting paid for preventive services, particularly those covered under the Affordable Care Act (ACA). Proper use of CPT modifier 33 can help.
Modifier 33 allows providers to indicate that a service was initiated as a preventive service (even if it turned out to be therapeutic) and that patient cost-sharing does not apply. It can be used with any preventive service covered under the ACA (see a list of covered preventive services), such as services rated “A” or “B” by the U.S. Preventive Services Task Force and immunizations recommended by the Advisory Committee on Immunization Practices.
For instruction regarding selecting the appropriate CPT or HCPCS codes for these preventive services, refer to the following articles:
Beckman KD. CPT and Affordable Care Act create payer conundrum. AAPC News. March 1, 2014.
Hughes C. What you need to know about the Medicare preventive services expansion. Fam Pract Manag. 2011;18(1):22–25.
ICD-10 recognizes that the type of vaccine you report with a CPT or HCPCS code gives sufficient detail about the type of immunization the patient needed. So rather than having you provide individual diagnosis codes for each vaccine, ICD-10 allows you to report code Z23 for an encounter involving immunization regardless of the type or number of vaccines. This is especially advantageous when reporting multiple childhood immunizations. Even influenza immunization coding is simplified. Under ICD-9, you have to report V04.81 for the influenza vaccine alone or V06.6 if you provide both the influenza vaccine and the pneumonia vaccine on the same date. Under ICD-10, you simply report code Z23 regardless of how many or what types of vaccines are administered.
The Z23 code includes the following note: “Code first any routine childhood examination.” Therefore, when you provide immunizations in conjunction with a well-child visit, a code for routine child health examination should be reported first, followed by Z23 for any immunizations. This is similar to ICD-9
About the Authors
Cindy Hughes is an independent consulting editor in Tonganoxie, Kan., and a contributing editor to Family Practice Management.
Copyright © 2014 by the American Academy of Family Physicians.
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