Wiki - Coding resolved conditions (2024)

You should check out this thread:

https://www.aapc.com/memberarea/forums/150122-opinions-please.html

So far, no one else has chimed in ... but we code a follow-up exam "after completed treatment" (Z09) with a "history of" code for the resolved condition.

I have the same question ---- but for pro-fee hospital visits

jperkins said:

Is it appropriate to code a resolved condition? Here's the situation. Pt came in for follow-up of "condition". HPI says condition was present, treated, and now appears to be resolved. There are no findings on exam. Under the impression and plan it says Dx 1-"condition"; resolved. Return to clinic yearly or if condition recurs. The physician wants to assign the ICD-10 code for the condition that is not there anymore.

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My providers may see patients for IP/OBS follow-up visits multiple days in a row with "diagnosis; resolved" and "patient feels much better today, no complaints" .... I personally do not find the visit appropriate to bill for. I understand why the providers would want to follow-up with the patient, to ensure their care is fully completed on a clinical level. However that doesn't mean it is billable, correct??

I love to hear some expertise and reasoning on this.

To be clear, here is an example:
Provider seen patient day 1 and 2 for abdominal pain, but then day 3 and 4 were resolved with no additional tests/findings/DX/conditions
Day 1 - Billed with Abdominal Pain (good)
Day 2 - Billed with Abdominal Pain (good)
Day 3 - Billed with ... Abdominal Pain??? ... Follow-up Z-code???
Day 4 - Billed with ... Abdominal Pain??? ... Follow-up Z-code???
....Are Z-codes even paid for pro-fee hospital visits??

I'd appreciate ANY input

thomas7331 said:

.... Presumably, if your provider is continuing to see the patient, then there is a reason for it but it may not be apparent in their documentation. In your example above, I would expect that this patient was not hospitalized four days just for abdominal pain, but because the patient had a particular type of pain or symptoms that were indicative of the risk of something serious enough to warrant four days of hospital care until it is completely ruled out.

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Yes Thomas, this was a consulting physician, and patient was still inpatient for reasons other than abdominal pain. I have spoken with my provider(s) regarding documentation and how I cannot (in my opinion, still unsure) code for a resolved condition, especially any additional visits after the condition has already been resolved.

Since leaving my last comment, over a month ago, I had begun billing with history of Z-codes (since I did not feel it was appropriate to bill for a resolved symptom or condition). I am currently getting paid for those services coded inpatient pro-fee with only a Z-code listed primary and no other diagnosis.... however, I'm sure we're all familiar with the understanding that "just because it got paid, doesn't mean it was right" ... And I am no newbie to insurance recoupment either So I just want to be sure I am correct in this!

I'm here, hoping to gain some backup on what to advise my provider(s) who continue to see these patients with ONLY resolved issues. I understand their point of wanting to "check-up" on those patients to ensure they are still without complaint, however I'm also advising that is the point of re-consult, as the check-up without current complaint/symptom/condition would not a billable visit.

Thank you for the input, it really helps!