Wiki Aftercare Z Codes

[melissa.reed22]

There is some debate about aftercare coding. For an example let's say a patient has a traumatic fracture, ORIF is performed, and now the patient comes back to the clinic 6 months later for a follow up visit. Some say the S codes should no longer be used even with a D for the 7th character because they're only for acute traumatic fractures, and at this point 6 months out if it's still not healed it's becoming a chronic issue. One person says to use Z09 only, but it's not acceptable as a primary diagnosis. How does everyone else code this type of thing?

 

[Ajesh Kuriakose]

Guidelines says for fracture and injuries use S code with D(subs encounter) no Z code

section 1.c. 19. a

Application of 7th Characters

7th character “D” subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, an x-ray to ICD-10-CM

check healing status of fracture, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition.

"The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter)".

section 1.c.19.c.1

Coding of Traumatic Fractures

Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, an x-ray to check healing status of fracture, removal of external or internal fixation device, medication adjustment, and follow-up visits following fracture treatment.
Hope this helps I haven't coded a scenario, just cleared the certification. So not sure how much my reply can be helpful.

 

[mitchellde]

There is some debate about aftercare coding. For an example let's say a patient has a traumatic fracture, ORIF is performed, and now the patient comes back to the clinic 6 months later for a follow up visit. Some say the S codes should no longer be used even with a D for the 7th character because they're only for acute traumatic fractures, and at this point 6 months out if it's still not healed it's becoming a chronic issue. One person says to use Z09 only, but it's not acceptable as a primary diagnosis. How does everyone else code this type of thing?

If the fracture has healed and this is just a follow up encounter, then the Z09 is the correct code. It is not the same as an aftercare Z code so the guideline regarding the use of aftercare Z codes is not applicable. And Z09 is an acceptable first listed code for physician and outpatient clinic. If your code book has a note regarding unacctable principle dx next to the Z09 listing, that note applies to inpatient coding of a principle dx code.

 

[rbandaru]

As per your Scenario Use 7th Character D.
Codes Z47.89 and Z09 are not appropriate here, because aftercare Z codes should not be used for aftercare involving injuries or poisonings, where 7th characters are provided to identify subsequent care. Routine aftercare and follow-up visits following active treatment of the injury are captured with the 7th character "D."

Regards
Dr.Ramnath Bandaru, CCS, CPC
American Medical Services LLC
http://amshealth.com/
Twitter: @HospitalCoders

 

[mitchellde]

Z09 is not an aftercare code it is a code for follow up. These are two different things. Follow up is defined as a condition that has healed/cured and requires no further treatment. It would be an appropriate code for a visit six months post fracture for a simple follow up visit. If the fracture is not healed then I agree a fracture code with the appropriate subsequent 7 th character to indicate non healing fracture would be appropriate.

 

[Ajesh Kuriakose]

Can you please clarify the quoted statement

If the fracture has healed and this is just a follow up encounter, then the Z09 is the correct code. It is not the same as an aftercare Z code so the guideline regarding the use of aftercare Z codes is not applicable. And Z09 is an acceptable first listed code for physician and outpatient clinic. If your code book has a note regarding unacctable principle dx next to the Z09 listing, that note applies to inpatient coding of a principle dx code.

"Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, an x-ray to check healing status of fracture, removal of external or internal fixation device, medication adjustment, and follow-up visits following fracture treatment."
These are exact same sentences in icd-10 guidelines, so it exactly says aftercare. Can you specify the guideline part that specifies use of "Z" code for aftercare following fracture.

 

[mitchellde]

Aftercare and follow up are two different things. It states aftercare for the healing or recovery phase is not coded with aftercare Z codes. Z09 is not an aftercare code. It is for follow up which is defined as a healed condition requiring no further care. If the fracture has healed then it is not healing, it has recovered and it is not non healing. Therefore the Z09 does fit and does not violate any guideline.

 

[Ajesh Kuriakose]

Thank you, got it now and Sorry I was thinking Z09 as an aftercare.