Wiki Z79.899 Prophylactic Medication

[Shughe5]

Is it appropriate to use Z79.899 to account for Benadryl taken 30-minutes prior to presentation when a patient is having an allergic reaction (rash) to food ingested. This patient has a history of an allergy to the same food and the medication is NOT listed on the patients long-term (current) medication list.

When looking in the index under prophylactic >medication > Z79.899; however, the tabular states Other long term (current) drug therapy.

I understand this code is not used for antibiotics given short term for bronchitis; however, when reviewing the ICD-10 Appendix C: Pharmacology List, there are several drugs listed as "prophylaxis" (i.e. an inhaled corticosteroid Z79.51 for an asthma exacerbation) it may not be used daily, but it was used prior to presenting. Since the patient has a diagnostic history that the medication is treating, is it appropriate to use Z79.899.

 

[ccr888]

"Prophylactic" for Motion Sickness

Is it appropriate to use Z79.899 to account for Benadryl taken 30-minutes prior to presentation when a patient is having an allergic reaction (rash) to food ingested. This patient has a history of an allergy to the same food and the medication is NOT listed on the patients long-term (current) medication list.

When looking in the index under prophylactic >medication > Z79.899; however, the tabular states Other long term (current) drug therapy.

I understand this code is not used for antibiotics given short term for bronchitis; however, when reviewing the ICD-10 Appendix C: Pharmacology List, there are several drugs listed as "prophylaxis" (i.e. an inhaled corticosteroid Z79.51 for an asthma exacerbation) it may not be used daily, but it was used prior to presenting. Since the patient has a diagnostic history that the medication is treating, is it appropriate to use Z79.899.

I came to the same conclusion when looking at the ICD-10 Index for a code for seasickness prophylactic for someone with a history of seasickness about to go on a cruise. My interpretation is that because the Index says "Prophylactic/medication Z79.899" (and the Chapter listing gives no exact "Excludes"), it would be appropriate to use. My logic is that if someone has a condition such as susceptibility to motion sickness, it would qualify just as it would under your scenario...or for someone who carries nitroglycerin for use when needed.

This seems to fall under the umbrella of discernment and working with the level of specificity that the ICD-10 currently offers.

C. Roskam
Newbie Coder

 

[thomas7331]

The Z79 series of codes carries a note of instruction in the Chapter 21 section of the ICD-10 Official Guidelines for Coding and Reporting as follows: "Codes from this category indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use....Assign a code from Z79 if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from category Z79 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis)."

As a 'status' code, the purpose of the code is to indicate the patient's ongoing use of a medication, which incidentally may be for prophylactic reasons. In my opinion the code would not be appropriate for the situation you describe, because using a Z79 code as a first listed code would indicate that the purpose of the visit would be for the provider to evaluate the patient's response to a medication already being used, not for evaluating a patient for prevention of a potential future problem. So I don't think this code correctly describes visits which are for preventive or prophylactic purposes, i.e. to prevent a problem which has not yet occurred and for which the patient is not yet receiving a drug. There are codes that can be used that describe encounters for 'other specified' reasons, and an 'other specified' history code to represent the patient's past history of seasickness would more accurately represent the reasons for the encounter as described in your post.