Wiki PT post-op

[sherrygalla]

Hi I am trying to bill for physical therapy post-op care for Medicare. I have the primary diagnosis code as Z47.89 but it has been denied. Can I not use a z code with Medicare as the primary diagnosis?

 

[krithika]

Hi,

As per the guidelines,

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).
7th character “S”, sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. When using 7th character “S”, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The “S” is added only to the injury code, not the sequela code. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.

So, please check what type of aftercare.

 

[thomas7331]

I disagree, Z47.89 is a valid code, and if this was not an injury or other code with a 7th character, then the diagnosis may be appropriate. But you haven't said what denial reason was given by Medicare - it may not have anything to do with the diagnosis, or the Medicare payer may be looking for other additional information.