Some diagnosis codes do not actually describe a condition, rather they simply explain the reason for an encounter with a health care provider. Classic medical examples include encounters for vaccines, or health screenings. In other words, these patients have no complaints, therefore there is no condition to report. In this type of case, ICD-10 codes can still explain the reason for the encounter. These codes are found in Chapter 21 of the Tabular List. They are easy to identify because they all start with the letter “Z.”
If a patient presents for an annual wellness exam (which would most appropriately be reported with Evaluation and Management codes from the range 99381-99397 Preventive Medicine Service), a few possible ICD-10 codes a healthcare provider might use are:
ZØØ.ØØ Encounter for general adult medical examination without abnormal findings
ZØØ.8 Other encounter for general examination without complaint, suspected, or reported diagnosis
The first code fits better for an annual general wellness check-up. The second might best describe an encounter for an annual exam for a patient receiving ongoing chiropractic wellness care. Keep in mind that most third-party payers do not reimburse chiropractors for these types of encounters, and the patient would be required to pay out-of-pocket. But it may be beneficial to use these codes so that a clinic can later pull reports that help track how many wellness exams are performed for a certain time period.
Wellness, or maintenance adjustments (HCPCS code S8990 Physical or manipulative therapy performed for maintenance rather than restoration) might work well with the following Z code:
Z41.8 Other encounter for procedure for purpose other than remedying health state
This code describes an encounter for a procedure, such as chiropractic manipulation, rather than an exam, like the Z00- codes suggested above. No health state is being remedied since the patient does not have any complaints. While these visits are also not likely to be reimbursed by third parties, it may be logical to assume that a patient would only receive an adjustment if a subluxation were found. Therefore, an additional code to consider for a wellness patient might be:
M99.1- Subluxation complex (vertebral)
The 5th character designates the anatomic region. These codes are not recognized as payable by many payers, but they seem to have been created just for chiropractors. The M99.0- segmental and somatic dysfunction codes are those typically used for reimbursable encounters when Chiropractic Manipulative Treatment (CMT codes 98940-98942) is performed. M99.1- might be perfect to describe a wellness patient, along with, or in place of Z41.8. In any case these codes would likely only be used for internal purposes.
To see the rest of the Z codes that might be useful for chiropractic, see pages 411-430 in your 2016 ICD-10 Coding for Chiropractic book.