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What is Aetna's approach to mapping ICD-9 codes to the ICD-10 codes? There is no industry standard for mapping. The Centers for Medicare & Medicaid Services (CMS) has provided General Equivalency Mappings (GEMs) as guidance for mapping between ICD-9 and ICD-10 codes.
ICD-10 Code Set Info The ICD-10-CM code set replaced the ICD-9-CM code set on October 1, 2015, for covered entities under the Health Insurance Portability and Accountability Act (HIPAA). ICD-10-CM uses different formatting and an expanded character set.
This is the American ICD-10-CM version of Z00.00 - other international versions of ICD-10 Z00.00 may differ. ICD-10-CM Coding Rules. Z00.00 is applicable to adult patients aged 15 - 124 years inclusive. Applicable To. Encounter for adult health check-up NOS. The following code (s) above Z00.00 contain annotation back-references.
Lab NCDs - ICD-10 Transition from ICD-9-CM to ICD-10-CM for the Lab NCDs Based on the 2010 Affordable Care Act (2010), the ICD-10-CM codeset is used (instead of ICD-9-CM) by all covered entities to encode diagnoses in HIPAA-regulated transactions, such as Medicare billing claims for diagnostic clinical laboratory services.
It is vital that all health care providers have correct information regarding ICD-10 and its implementation. The International Classification of Diseases (ICD) is used to report medical diagnoses and inpatient procedures. The 10th revision of this code set (ICD-10) replaces ICD-9.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
The ICD-10-CM code set replaced the ICD-9-CM code set on October 1, 2015, for covered entities under the Health Insurance Portability and Accountability Act (HIPAA). ICD-10-CM uses different formatting and an expanded character set.
AAPC is the country’s largest coding training and credentialing organization for the business side of health care. Their certified members in medical coding, medical billing, medical auditing, compliance, and practice management represent the highest level of expertise in the industry.
In Chiropractic and PT, many patients elect to continue care, paying out of pocket and most often, providers are directed to use HCPCS code S8990 to describe that service. We have always been counseled to use one of the following, non-payable, generic ICD-10 code:#N#Z00.00 "encounter for general adult medical examination"#N#Z00.8 "encounter for other general examination"#N#Z13.828 "encounter or screening for musculoskeletal disorder"#N#With regards to the instructional note for "Persons encountering health services for examinations Z00-Z13" the question is, what is considered 'health services" or "limited care"? Does maintenance care, procedure code S8990 fall into the category as health services or limited care as listed in the Z codes?#N#We have also been advised to use this code, based on the fact that a procedure is performed:#N#Z41.8 "encounter for other procedures for purposes other than remedying health state"#N#Instructional notes for this category Z40-Z53 says: "are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state"#N#For example, office notes would NOT have a medically necessary encounter...could say something like "Patient has some stiffness in low back and feels he needs an adjustment to assist with performing in sport activities. Normal ADLs. Normal ROM"#N#That said, is there one of these that makes more sense than another, or should we consider that since we are not seeking third-party reimbursement, it really doesn't matter?
You cannot use Z00.8 because again you are not performing a general exam. you cannot use the Z13.828 unless the patient is completely asymptomatic and you have some criteria for the screening such as family history. for Z41.8.. as the category indicates this is a code for aftercare.