Pediatric Coding Alert

Follow-up codes mean care is over, not ongoing.

When you think of follow-up, you probably think of ongoing treatment for a patient. Quite logically, you might even think of other, similar terminology like "aftercare," "monitoring," or "surveillance."

But when it comes to encounter codes, each one of these terms carries a different, specific meaning that could have a big impact on your ongoing care coding.

So, here are four myths to bust that will help you report ongoing care encounter codes easily and accurately.

Myth 1: Follow-up means aftercare

The first problem coders might encounter comes when they confuse these two terms. The ICD-10-CM official guidelines make the following distinction between follow-up and aftercare, noting that "the follow-up Z code categories imply that the condition has been fully treated and no longer exists." The codes in question are:

• Z08 - Encounter for follow-up examination after completed treatment for malignant neoplasm
• Z09 - ... for conditions other than malignant neoplasm
• Z39 - Encounter for maternal postpartum care and examination

The guidelines go on to note that "they should not be confused with aftercare codes," which "cover situations when ... the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease."

Pediatric coders would be most familiar with Z09, which they use, as Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC points out, "after completed treatment."

Donelle Holle, RN, President of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, agrees, adding further clarification that Z09 "will be used for all follow-up visits when the patient has finished their treatment plan, such as antibiotics, steroids, any type of medication, regardless of who put the patient on the medication." Coders, she explains, "need to use this code first and then use a secondary code for a history of a disease."

This is in contrast to the main group of aftercare codes, Z42-Z49, which ICD-10 clarifies "are for patients who have already been treated for a disease or injury, but who are receiving aftercare." These codes are much more detailed in nature, and include such pediatric-oriented encounters as Z41.2 (Encounter for routine and ritual male circumcision) and Z43.0 (Encounter for attention to tracheostomy).

So, Blanchard summarizes, "timing and specificity" are the key terms that will help you understand the difference between follow-up and aftercare. "When there are more specific subsequent care codes for an injury," Blanchard clarifies, "they would supersede the more general follow-up codes," making Z08-Z09 and Z42-Z49 Excludes1 codes per ICD-10 guidelines.

Myth 2: Follow-up means monitoring

Another group of aftercare codes, the Z51 (Encounter for other aftercare and medical care) code group, can also be confusing to coders. "Because the variations of Z51 are so specific," Blanchard explains, like Z42-Z49 "they are mutually exclusive to Z08 and Z09." So, a code such as Z51.81 (Encounter for therapeutic drug level monitoring) is classified as an Excludes1 for any of the follow-up codes, as are all the codes in the Z51 group.

Myth 3: Follow-up means surveillance

Even though the notes that accompany Z08 and Z09 point out that these codes are to be used for "medical surveillance following completed treatment," you'll also get into trouble if you use Z30.4- (Encounter for surveillance of contraceptives, unspecified), which is another Excludes1 code for Z09. So, too, are another group of codes from the Z42-Z49 group, Z44-Z46, which are described in the notes for Z09 as "surveillance of prosthetic and other medical devices."

Myth 4: Follow-up means subsequent encounter

Finally, ICD-10-CM guidelines remind coders that "injury codes with a 7th character for subsequent encounter[s]" should not be confused with the follow-up codes. The guidelines accompanying Chapter 19, "Injury, poisoning, and certain other consequences of external causes" go on to explain that most of the "S" and "T" codes take a seventh character, and that when the subsequent encounter character, "D," is attached, you should not follow-up codes, or aftercare codes, in your documentation.

As Holle explains, coders "would not usually use the Z code for a recheck for an injury because they will normally use the injury diagnosis code with a subsequent encounter. This means the injury, accident, or poisoning is now in the healing stage."

So, you would document a patient reporting back to your pediatrician for subsequent care following a displaced oblique fracture of the left fibula with S82.432D (Displaced oblique fracture of shaft of left fibula, subsequent encounter for closed fracture with routine healing), as this, according to Blanchard, would be "simply a more relevant, meaningful choice than any of the catch-all Z codes."