Wiki Removal of internal fixation device Dx

[ZaleskinJ]

The patient had both internal and external fixation devices on his leg for a fractured femur. The procedures performed were the removal of internal fixation screws and an external fixation device, 20680 RT and 20694 59,LT. Those make sense. What has me confused is the Dx. To Dx the removal of the external device, we code the fracture with 7th digit D, so far so good. To code the removal of the INTERNAL device, we use Z47.89, aftercare/orthopedic NEC. Why not Z47.2, Encounter for removal of internal fixation device. That seems to me a more specific Dx than general aftercare.

 

[thomas7331]

The ICD-10 guidelines, section I.C.19.a, specify that aftercare Z codes are not to be used for injuries since the subsequent encounter codes are available:

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).

 

[ZaleskinJ]

Thank you for the response. I saw that guideline too, but the practicum solution actually says to use both the fracture code with 7th character D (as the reason for the removal of the external fixation) AND the aftercare code (as the reason for the removal of the internal fixation). The whole case seems a bit off. If you aren't supposed to use aftercare codes for injuries, why would the solution include one, and mark you down for not using it? Which then leads back into the question as to why you would use a general aftercare code rather than the more specific removal of an internal device code.