Wiki Follow up after hernia surgery dx codes

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frankal

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What advice would anyone have for dx codes for a patient that is following up in the office that previously an had abdominal hernia repair? Example: Pt came in today for follow up to her incisional hernia repair that was performed 2 weeks ago. The new 2023 abdominal hernia repair codes have 000 global period. I am charging an E/M code for this visit. Would I use dx codes Z09, Z98.890 and K43.9? Any advice would be great!!
 
Ok, so I informed my provider with the response I received to just use Z09 and Z98.890. He is questioning this because he believes that there will not be any reimbursement for the E/M code since there are only Z codes listed and being used for the primary diagnosis. He thinks that K43.2 (incisional hernia) should be listed first, followed by the Z codes. Can somebody explain to me what dx codes they would use when coding for a post op follow up to an incisional hernia repair when there is no global package for the repair to get paid?
 
frankal said:
Ok, so I informed my provider with the response I received to just use Z09 and Z98.890. He is questioning this because he believes that there will not be any reimbursement for the E/M code since there are only Z codes listed and being used for the primary diagnosis. He thinks that K43.2 (incisional hernia) should be listed first, followed by the Z codes. Can somebody explain to me what dx codes they would use when coding for a post op follow up to an incisional hernia repair when there is no global package for the repair to get paid?
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In my opinion, @lgardner gave you the correct coding above and I agree it would be incorrect to code the hernia since it is a condition that no longer exists.

Although you never can completely predict what a payer will do with a claim, there is no reason to believe that the provider will not be paid simply because there are only Z codes listed. Even so, you can't code a claim incorrectly just because you or your provider is concerned about not getting paid.
 
thomas7331 said:
In my opinion, @lgardner gave you the correct coding above and I agree it would be incorrect to code the hernia since it is a condition that no longer exists.

Although you never can completely predict what a payer will do with a claim, there is no reason to believe that the provider will not be paid simply because there are only Z codes listed. Even so, you can't code a claim incorrectly just because you or your provider is concerned about not getting paid.
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I appreciate everything from both of you. I just wanted to clarify more in detail for my providers. For me as a medical coder, these dx codes provide enough information for the visit. Thank you so much!
 
I thought Z09 "... should not be confused with aftercare codes, or injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition or its sequela..." would that mean we would not use Z09 with status post hernia repair icd code?
 
Z09 can be coded for Hernia repair as per the ICD Navigation, followup examination for any specified conditions leads to Z09, However aftercare codes doesnt relate to this as it will mostly related to Musculoskeletal procedures.
"Aftercare visit codes" cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases.”
"The follow-up codes" 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 insists Hernia is repaired and condition is No more its fully treated.
 
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