Wiki Z codes for non traumatic orthopedic conditions

[Katie_Ellis]

We have a payer saying that Z09 and Z47.89 is too generic and we must send in corrected claim. What more specific ICD 10 would you use for i.e. bunion/hammertoe surgery or achilles reconstruction with the indication of tendinitis? We do a lot of procedures that are not due to injuries and we are having a difficult time figuring out what to use besides personal hx of other musculoskeletal condition. I see that being denied as too vague as well. I explained to the rep that you cannot code for a condition that has been resolved with surgery but he did not understand that. Any input would be great. TIA

 

[AlanPechacek]

If an Orthopedic procedure was performed for an Orthopedic Condition/Disease, then Z09 really doesn't apply, but Z47 does as it is for Orthopedic Aftercare (for non-traumatic conditions). Since Z47.89 is for an Encounter for "other orthopedic aftercare," it would be the most correct, but I would add the diagnosis code for the condition treated, and maybe even the procedural code for the procedure done. Give the payer all the codes that are relevant to the condition and then let them sort it out. That way they can't come back and say you didn't provide everything pertinent.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com