Coding & Documentation

It depends on the documentation. Report mild cognitive impairment (G31.84) only if you specifically state it as the diagnosis. It indicates that patients have diminished memory (or any other cognitive domain) beyond what is considered normal for their age. Age-related cognitive decline, reported with R41.81, would probably be a more appropriate diagnosis for the scenario you’ve presented. If you had noted attention and concentration deficits (with no other condition identified as the cause), R41.840 would be appropriate. If you had identified cognitive deficits that resulted from a stroke, that would be reported with codes in category I69, “Sequelae of cerebrovascular disease.”

You are correct to report the signs or symptoms that prompted you to order the test even when the test does not yielda confirmed or definitive diagnosis. (General symptom codes are found in the R50-69 range. Examples include R53.83, “Other fatigue,” and R60.9, “Edema, unspecified.”) Code Z01.89 is for routine testing in the absence of symptoms or an associated diagnosis when it is not performed as part of a routine health examination. ICD-10 instructions for codes in category Z01 specify that those codes are not reported for laboratory, radiologic, and imaging examinations based on signs and symptoms and that codes for the signs or symptoms should be used in those situations instead. The instructions also advise that laboratory and radiologic examinations provided as components of general medical examinations are reported with the general adult health examination codes in subcategory Z00.0-(additional character required).

Yes, code 99173 is separately reportable per CPT. However, some health plans will bundle the services and not pay code 99173 on the same date of a preventive medicine service (codes 99381-99387 or 99391-99397). Other payers, including some Medicaid plans, do pay a separate fee for code 99173 when reported with children’s preventive medicine E/M services but only at certain ages (e.g., 3–5 years). You may want to have an office or billing manager investigate the policies of the health plans your practice commonly bills. Routine vision and hearing testing are included under ICD-10 codes for routine child health examination (Z00.121 and Z00.129), so no additional diagnosis code is required.