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tci General Surgery Coding Alert - 2020 Issue Q2
Reader Question: Laser Focus Reason for Visit
Question: A patient presented in the surgeon’s office for an evaluation of a suspected hernia that might require surgery. Following a thorough exam, the surgeon determined that the patient did not have a hernia. Should we use Z00.00 as the diagnosis for the surgeon’s E/M service, or should we report a hernia code?
Virginia Subscriber
Answer: No, you should not list Z00.00 (Encounter for general adult medical examination without abnormal findings) as the diagnosis for this encounter. You should reserve that code for cases involving an asymptomatic patient, with no specific complaint or problem, presenting...
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