Wiki Billing and coding question help

[bdurham67@gmail.com]

Hello,

Can someone please advise if when a patient sees a provider for a g-tube change should the following ICD-10 codes be reported for proper billing purposes?
G-tube was changed: encounter for attention to g-tube Z43.1 needs to be stated?
Reason G-tube was changed – notes stated that the there was a small split in one of the ports : K94.24 – using this code to indicate “other complications of g-tube”?
Some of our providers code Z93.1 for g-tube status. We work out of a non-facility(clinic) and I believe that, that code is for facility reporting only?

Should K94.24 and Z43.1 be used or K94.24, Z43.1 and Z93.1??

Thanks so much for your help with this.
Beverly

 

[mitchellde]

If you look in your code book, you will see that when you code the K94, it exclude 1 excludes all Z43 and Z93 codes. therefore code only the K94.24

 

[bdurham67@gmail.com]

Thanks...

Hi Michelle,
Thanks so much, so if they didn't report the K94.24 and only reported the Z43.1, would that be acceptable?

I also was looking in my code book and couldn't seem to find the excludes for that K94... excludes explanation. I even looked in Optum360 encoder. Where did you see it actually?

Thanks.

 

[mitchellde]

if complications are documented then you should use the K94 code. I am not sure why your book does not show the excludes note I have it in my book and the online ICD-10 Data source also shows it.. Things that make go hmmmm. but lets apply logic then if you have code that states gastrostomy complications, or fitting and adjustment of gastrostomy then you do not need a code for gastrostomy status as that is already inherent in the code. then if you have a complication of a gastrostomy that code should be enough to support medical necessity for any procedure to repair or replace as you would not just leave it that way so the fitting and adjustment would be inherent to the complication code.

 

[bdurham67@gmail.com]

Understood!

Got it! Yes, I agree, thanks so much Debra, I appreciate the explanation.

Sorry about calling you Michelle before

I'm still not sure why I am not seeing the excludes part but I will take your answer from a logical point of view as you noted.

- Beverly