You may think that if there’s a code for injury from burning water skis, there must be a code for preventative care for travelers. After all, you see more travelers in your office than people injured from burning water skis.
But you’d be wrong.
Tomorrow we go ‘live’ with ICD-10 and many providers have questions about how to bill for travel related healthcare services that they offer in their general medical practice. This is an especially common problem for pediatricians.
In a sense, it’s good news for us. Billing for preventative care for travelers is the same. It’s hard to believe that with 70,000 different diagnosis codes that not much changed, but it’s true. The billing code numbers have changed, but the diagnosis and billing procedures are the same.
Of course, if your patient is an ill returned traveler there are now a plethora of diagnoses. For that you’ll use your EMR’s code finder to sort it all out.
But what if you are simply seeing someone before they travel? To give advice, needed medications, and/or vaccines?
In that case there are only a few things you need to know:
- You are billing for the time to give advice: The diagnosis commonly used is “Other specified counseling” Z71.89. Some of my colleagues prefer a similar Z41.8 “Encounter for other procedures other than remedying health sate”. No authoritative organization has endorsed either code as the ‘right’ code. You bill based upon the amount of time spent with your patient, in 15-minute increments. (99401-99404)
- You can’t bill for advice given on top of a well visit. To be reimbursed for your counseling time it has to occur on a separate day. Not fair, but that’s the rules.
- You can bill for management of a chronic illness such as asthma, etc as it relates to travel using E & M codes (99213-99215) This can be done on the same day as a well visit if you document correctly and use modifier -25.
- Vaccine visit codes have changed. Use Z23. The old codes (V06.0-V06.9 & V03-V05) are now associated with various injuries. The CPT codes for vaccines have remained the same.
- Many insurance policies do not cover this service. ‘Other specified counseling’ is often a carve out; you will need to have a system in place to advise your patients about potential fees involved. Many providers collect payment at the time of the visit and reimburse if the insurance pays the claim.
Some helpful resources have popped up to help you adjust to the new system:
- The best resource I have seen is the ICD-10 Charts offered by MPR here
- You can double-check any code with CMS to see the exact billing diagnosis here
- The Immunization Action Coalition has numerous resources available here
ICD-10 Codes for Travel
|ICD-10 Code||Diagnosis||ICD-9 Code||How to BIll|
|Z71.89||Other specified counseling||V65.49||Based upon time spent|
|Z41.8||Encounter for other procedures than remedying a health state||n/a||Based upon time spent|
|Z23||Encounter for immunization||varied||Bill like all other vaccines|
|Z28.89||Immunization not carried out for other reason||V64.09||Vaccine counseling is part of total time spent with patient|
|Z28.29||Immunization not carried out because of patient decision for other reason||V64.09||Vaccine counseling is part of total time spent with patient|
|Z28.09||Immunization not carried out because of contraindication||V64.09||Vaccine counseling is part of total time spent with patient|
|Z28.20||Immunization not carried out because of patient decision for unspecified reason||V64.09||Vaccine counseling is part of total time spent with patient|
Full disclosure: I am not a coding specialist, I just like ‘clean claims’. If you have suggestions or comment please leave them in the comment section below.
We can all help each other if we share what we know. We are ‘off to the races’ with ICD-10. I hope this helps makes your transition as smooth as possible.