May 17, 2018
Claims are sometimes submitted to Premera with an incorrect age-banded diagnosis code for the patient’s age at the date of service, resulting in claims edits and a slower reimbursement process. This is particularly prevalent when coders are selecting health exams for newborns and routine child and general health exams, or choosing Body Mass Index (BMI) diagnosis codes.
In Premera’s claims editor, the age bands for the general health examination diagnosis codes include the following:
- General adult health examinations: (Ages 18 years and above)
- Z00.00 – Encounter for general adult medical examination without abnormal findings
- Z00.01 – Encounter for general adult medical examination with abnormal findings
- Newborn examinations:
- Z00.110 – Health examination for newborn under 8 days old
- Z00.111 – Health examination for newborn 8 to 28 days old
- Routine child examinations (Ages 29 days up to 18 years)
- Z00.121 – Encounter for routine child health examination with abnormal findings
- Z00.129 – Encounter for routine child health examination without abnormal findings
To avoid the hassles of resubmitting a claim, pay close attention to these age-banded diagnosis codes for general health examinations. This will help your claim process quickly and prevent claims edits.