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ICD10 for long term use Semaglutide/Dulaglutide for non-diabetic patients

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arrana

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Local Chapter Officer
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Our office does complete code capture, but we are not clear if we can add Z79.85 when an obese patient is prescribed Wegovy for weight loss, but does not have diabetes. I'm looking for official guidance on coding for long-term use of semaglutide or dulaglutide (Wegovy/Ozempic/Trulicity) when prescribed for weight loss for non-diabetic patients.

Similar, but different... If a patient with pre-diabetes is prescribed Metformin, do we code Z79.84?

Thank you.
 
Hello,

All of the drugs listed above are considered to be anti-diabetic medications and are used to either treat or prevent diabetes or obesity. So, Z79.84 & Z79.85 would apply in your scenarios. The below references as it relates to the drugs may be helpful.


Hope this helps!
 
@keke74 I do agree that they are antidiabetic drugs, but they are not being used that way unless the patient is diabetic or pre-diabetic. I am concerned about using that code if the patient is not using the medicine for that. Especially since it could have a negative effect on the patient's insurance and premiums. Are you adding that code to patients who take metformin for PCOS? I did do some research as I have never added that code to a patient with PCOS who is on Metformin or honestly, to an obese patient who takes the drugs above for weight loss. The coding guidelines reference them in the diabetes section. I am not saying one way is right or wrong, I am just asking for clarity. I am going to see what else I can find about it as the code book has a reference to the AHA
 
I understand the concern for not wanting to mess up a patient's insurance coverage when using a drug off-label, but for coding purposes the patient is a long-term user of the non-insulin anti-diabetic medication regardless of whether or not they are actually diabetic.
 
arrana said:
Our office does complete code capture, but we are not clear if we can add Z79.85 when an obese patient is prescribed Wegovy for weight loss, but does not have diabetes. I'm looking for official guidance on coding for long-term use of semaglutide or dulaglutide (Wegovy/Ozempic/Trulicity) when prescribed for weight loss for non-diabetic patients.

Similar, but different... If a patient with pre-diabetes is prescribed Metformin, do we code Z79.84?

Thank you.
Click to expand...
If pt overweight or morbid obese use dx E66 or E63 blocks add the BMI % weight of Z68. Then add the medication if used to help weight loss and Z71.3 Diet modification last. Ensure this is document in current record too. The payer will understand
Lady T
 
The coding clinic referenced above is confusing as both semaglutide and tirzepatide are listed by name in Appendix A: Z codes for long-term use of drugs in the 2026 ICD-10 code book and code to Z79.85. :unsure:
 
miriambroyles said:
The coding clinic referenced above is confusing as both semaglutide and tirzepatide are listed by name in Appendix A: Z codes for long-term use of drugs in the 2026 ICD-10 code book and code to Z79.85. :unsure:
Click to expand...

Remember that the 2026 ICD-10-CM code book was printed in 2025 for an effective date of October 1, 2025.

The Appendix A disclaimer also states that “Drugs listed in this table were current at the time of printing.”

The Q1 2026 Coding Clinic guidance is newer and provides more current clarification regarding these medications.

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sls314 said:
You would follow the coding clinic guidance. It's the most current information.
Click to expand...
So you would say to follow the coding clinic and use the unspecified code for all long-term uses of semaglutide and tirzepatide (as the coding clinic does not differentiate what the meds are used for for code selection)?

Clarification from AHA would be most helpful as the coding clinic contradicts the code that was specifically classified for long-term use of these meds in Appendix A. 🤷‍♀️
 
Looking through my appendix A, semaglutide and tirzepatide aren't in the index under their generic names but only under brand names ozempic and mounjaro. the generic names alone are not on the list and neither are zepbound or wegovy. With this understanding I agree you should code unspecified. Ozempic is an anti-diabetic drug, but semaglutide inherintly is not (the index also has rybelsus as an oral hypoglycemic, not an anti-diabetic) and the medication has different dosage instructions if being used for diabetes or weight loss. Contrarily, metformin is listed under it's generic name but is classified as an oral hypoglycemic, with indications for dm but not as an anti-diabetic drug.
 
jodielonkoski said:
Looking through my appendix A, semaglutide and tirzepatide aren't in the index under their generic names but only under brand names ozempic and mounjaro. the generic names alone are not on the list and neither are zepbound or wegovy. With this understanding I agree you should code unspecified. Ozempic is an anti-diabetic drug, but semaglutide inherintly is not (the index also has rybelsus as an oral hypoglycemic, not an anti-diabetic) and the medication has different dosage instructions if being used for diabetes or weight loss. Contrarily, metformin is listed under it's generic name but is classified as an oral hypoglycemic, with indications for dm but not as an anti-diabetic drug.
Click to expand...
Hmmm, I find both semaglutide and tirzepatide listed by name in Appendix A, which was the issue mentioned on the May 27, 2026 post. I find Wegovy in Appendix A by name as well.

ICD 10 Guide book with Appendix A was effective October 2025.
Coding clinic stating there is no code for these meds was Q1 2026.
 
miriambroyles said:
Hmmm, I find both semaglutide and tirzepatide listed by name in Appendix A, which was the issue mentioned on the May 27, 2026 post. I find Wegovy in Appendix A by name as well.

ICD 10 Guide book with Appendix A was effective October 2025.
Coding clinic stating there is no code for these meds was Q1 2026.
Click to expand...
Hmm. I do not see the listed by name in my AMA icd-10 appendix B, frustrating how there can be discrepancies in published books.. Either way the coding clinic is then a direct conflict with AAPC appendix A as well as the article I posted above. It would be nice if there was a central system for guidance on these issues instead of conflicting posts... I hope they add a more specific code for these medications, especially since they are differently dosed. Personally I feel more comfortable classifying them with Z79.899 citing the coding clinic. AAPC appendix A classifying semaglutide alone as an anti-diabetic also conflicts with AMA appendix B classification of rybelsus (also semaglutide) as an oral hypoglycemic, codify (so i assume your appendix A) does not have rybelsus listed, so based on that you would code rybelsus as z79.85 when it's not an injectable..... which will also be an issue with the now made wegovy pill.
 
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