www.aapnews.org Volume 36 • Number 11 • November 2015
from the AAP Division of Health Care Finance
Following are answers to some frequently asked
questions submitted by AAP members and their staff
about International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).
Q. When is it appropriate to report the health exam
for a child with abnormal findings code (Z00.121)? If
we do report the code for “with abnormal findings,”
are we required to report a separate evaluation and
management (E/M) service?
A. There is no official guidance within Coding Clinic
(the official supplement to ICD-10-CM). The Academy is asking for this to be addressed.
The AAP Coding for Pediatrics manual states that
even a minor finding that may not be addressed with
a separate E/M service would merit reporting of
Z00.121. Likewise, a body mass index (BMI) that the
physician considers abnormal would support reporting
of Z00.121 and the appropriate BMI code.
Based on this, any abnormality that is present at the
time of the routine examination may lead to reporting
Z00.121 and a secondary code to describe the finding.
The new ICD-10-CM code does not impact any CPT
guideline. Just because an abnormality is discovered
during the routine well-child exam does not mean that
a separate E/M service should or can be reported. If
the criteria are met for reporting a significant and sep-
arately identifiable E/M service in addition to the pre-
ventive medicine service, then one should be reported.
Reporting the Z00.121 does not automatically equate
to a separate E/M service.
As for modifier 25, again CPT guidelines will not
be affected. Therefore, if you are reporting two distinct
E/M services, then modifier 25 is required on the “sick”
office visit code.
Q. Is there only a single code in ICD-10-CM for
vaccines as opposed to the more specific codes in
A. Yes, there is only one code (Z23) to report for any
vaccine encounter, regardless of what is administered.
Report code Z23 only once per encounter regardless
of the number of vaccines given. Also, link the CPT
codes for the product and the administration to code
Z23, and report Z23 in addition to any well-child
health exam code.
Q. How do I report an encounter for a follow-up visit
when the condition has been resolved?
A. Per the ICD-10-CM guidelines, you do not code
conditions that previously were treated and no longer
exist. The follow-up codes (Z08, Z09, Z39) are used
to explain continuing surveillance following completed
treatment of a disease, condition or injury. They imply
that the condition has been fully treated and no longer
exists. Follow-up codes may be used in conjunction
with history codes to provide the full picture of the
healed condition and its treatment. The follow-up code
is sequenced first, followed by the history code.
See ENDS, page 8
by Harold J. Farber, M.D., M.S.P.H., FAAP
For the first time, the Academy has released three linked, evidence-based statements to help protect children from tobacco
addiction and exposure. The policies call for raising the minimum age to purchase tobacco to 21 years; urge pediatricians to
screen patients for use of tobacco and nicotine delivery devices;
and address tobacco dependence in parents as part of pediatric
The policies and a technical
report grading the evidence supporting the policies are available
online and appear in the November issue of Pediatrics (See resources on page 4.).
A related policy statement
Electronic Nicotine Delivery Systems
also is available online and appears
in the November Pediatrics (See
article at right.). All of the documents are from the AAP Section
on Tobacco Control.
Harms of tobacco use, exposure
Tobacco addiction and tobacco smoke exposure are among the most import-
ant, preventable causes of sickness, disability and premature death in both the
by Susan C. Walley, M.D., FAAP
Pediatricians should screen families and counsel them on the
health risks of electronic nicotine delivery systems (ENDS),
which include electronic cigarettes (e-cigarettes), according to
a new AAP policy statement.
Electronic Nicotine Delivery Systems addresses pediatricians’
and pediatric health care providers’ questions about these products and the harms
to youths. It is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-3222
and is published in the November issue of Pediatrics.
ENDS are handheld devices that produce an aerosol from a solution typically containing nicotine, flavoring chemicals and propylene glycol
and/or glycerin to be inhaled by the
user. ENDS include the wide range
of products that are known as electronic cigarettes, e-cigs, e-hookah,
vaping devices, vape pens and mechanical mods.
In 2014, more youths reported
using ENDS than any other tobac-
co product. The Academy is calling
on pediatricians to ask about use
of ENDS when screening for tobacco use and exposure. Pediatricians should
counsel youths and parents on the following:
• Harms for users. In addition to nicotine, ENDS solution has been shown
to contain numerous toxicants and carcinogens harmful to human health.
AAP releases multiple policies to
protect youths from tobacco, nicotine
AAP policy cites harms of
e-cigarettes; urges screening
See Tobacco, page 4
AAP fields questions from members about ICD-10-CM
In this issue
AAP awarded $33.4 million federal grant
The Academy received a federal grant to support health in
early childhood education and establish a National Center
on Early Childhood Health and Wellness. See page 8.
See Coding, page 7