animal bite prompting rabies series

sara4044

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Looking for a little help on those who have encountered patients with an injury necessitating a rabies series. My questions are on the follow up visits for the second, third etc, rabies shots.

Person seen in ED for animal bite, patient given first shot in rabies series
primary dx coded is: S81.852A Open bite, left lower leg, initial encounter
secondary dx coded is: W54.0XXA Bitten by dog, initial encounter


On the next visit three days later, the diagnosis coded by an outside agency, was Z23 Encounter for Immunization.

HPI states seen on XX-XX-XXXX for dog bite, presents for 2nd rabies immunization. No C/Os wound healing w/o complication. No s/s infections.
PE extremity exam is positive for Other, healing wounds L upper and lower extremities. Lower extremity with surrounding resolving ecchymosis. No S/S infection.
Primary Impression: Need for Rabies Vaccination
Additional Impression: Visit for wound check.


Wouldnt the initial diagnosis S81.852 come into play over the Z23, with the appropriate letter (D) indicating this was a follow up visit? I am having a hard time finding support or information on this so maybe someone else can provide some assistance? Or point me to more specific information on this topic?

Thanks for any help!
 
You would code the wound code with a D and the Z23 for the immunization. Either can be first listed as the visit was for both reasons.
 
Unless there are only Z codes being billed I'd put it last. The most important is the injury (with the D) as its the medical necessity for the visit.
 
Animal bite prompting rabies series

Hello,

As per the above scenario Patient came to office only for vaccination, no other treatment was performed. So Z23 (Encounter for the immunization) will be the Principle diagnosis.
If any treatment was performed on wound like dressing, cleaning, suture removal, etc, we can assign 7th Character as D and assign Principle diagnosis and secondary Z23.


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

Twitter: @HospitalCoders
 
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