Gastroenterology Coding Alert

Hint: Some will affect medical decision making (MDM).

There are almost 1,500 ICD-10-CM changes scheduled to take effect on Oct. 1, 2022, and gastroenterology coders will soon have a handful number of new Z79 (Long term (current) drug therapy) codes from Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) to report. Here are a few that you’ll need to digest.

Understand the Purpose of Z79 Codes

Section I.C.21.c.3 of the ICD-10 Official Guidelines tells you to “assign a code from Z79 if the patient is receiving a medication for an extended period as a prophylactic measure … or as treatment of a chronic condition… or a disease requiring a lengthy course of treatment (such as cancer).” The guidelines also emphasize the importance of coding for anything that will impact MDM. Furthermore, Z codes are appropriate to help explain why a patient is presenting to a healthcare facility or is transferring between facilities.

Code expansion: Currently, the code set goes from Z79.5- (Long-term (current) use of steroids) straight to Z79.8 (Other long term (current) drug therapy). Going forward, you can expect to be able to account for the use of immunomodulators and immunosuppressants and chemotherapeutic agents with the following codes:

• Z79.6 (Long term (current) use of immunomodulators and immunosuppressants),
  • Z79.60 (Long term (current) use of unspecified immunomodulators and immunosuppressants)
  • Z79.61 (Long term (current) use of immunomodulator)
  • Z79.62 (Long term (current) use of immunosuppressant)
    • Z79.620 (Long term (current) use of immunosuppressive biologic)
    • Z79.621 (Long term (current) use of calcineurin inhibitor)
    • Z79.622 (Long term (current) use of Janus kinase inhibitor)
    • Z79.623 (Long term (current) use of mammalian target of rapamycin (mTOR) inhibitor)
    • Z79.624 (Long term (current) use of inhibitors of nucleotide synthesis)
  • Z79.63 (Long term (current) use of chemotherapeutic agent)
    • Z79.630 (Long term (current) use of alkylating agent)
    • Z79.631 (Long term (current) use of antimetabolite agent)
    • Z79.632 (Long term (current) use of antitumor antibiotic)
    • Z79.633 (Long term (current) use of mitotic inhibitor)
    • Z79.634 (Long term (current) use of topoisomerase inhibitor)
  • Z79.64 (Long term (current) use of myelosuppressive agent)
• Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs)

Report Z79.62- When Treating Common GI diseases

“Offices that do immunosuppressant infusions will more than likely utilize codes such as Z79.62- for most of the patients’ visits. These patients are typically on these medications long-term,” says Halee Garner, CPC, CPMA, CCA, certified coder for Digestive Health Partners in Asheville, NC. This is because immunomodulators and immunosuppressants are used to treat two major chronic inflammatory bowel diseases: Crohn’s disease (CD) and ulcerative colitis (UC). Immunosuppressants are known to globally impair the body’s entire immune response, whereas immunomodulators are more selective and target portions of the immune system. They both interfere with the immune system, and therefore the risk of infection is greatly increased, potentially affecting the future health of the patient.

“Adding a diagnosis from this expanded category provides a better electronic explanation of these tests or treatments,” explains Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist, University of Pennsylvania Department of Medicine, Hospital of the University of Pennsylvania. “When patients present for infusion services or require laboratory testing to ensure drug efficacy and safety, the claim reporting is better serviced with the addition of a specific Z79 code that identifies the therapy the patient is receiving,” she adds.

Factor in Z79.63- for Chemo Side Effects

While chemotherapy is not typically something administered by a gastroenterologist, you’ll still need to master these new codes as chemotherapy can cause side effects that include GI symptoms such as nausea, vomiting, diarrhea, and constipation.

E/M alert: Chemotherapy, and the cancer itself, can be enough to bump an evaluation and management (E/M) service potentially to 99215 (Office or other outpatient visit for the evaluation and management of an established patient … high level …). That’s because drug therapy requiring intensive monitoring for toxicity is an example of the high risk of complications of patient management element of medical decision making (MDM), while the patient’s condition may also rise to the high level of number and complexity of problems addressed element of MDM. So, reporting a code such as Z79.63 may support the higher-level E/M.

Note: Be on the lookout for when the Centers for Medicare & Medicaid Services (CMS) adds these codes to the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) lists. “Ordering lab work to monitor patients on these newly represented medications may not be covered if reported with Z79.8 or Z79.899,” Garner cautions.