At this point in your ICD-10 journey, it’s likely you’ve noticed that the letters A through Z are no longer reserved for the tiny noodles floating in your favorite childhood soup. In fact, when it comes to ICD-10 coding, you could say that your payments hinge on selecting the correct letter. In ICD-10, letters can indicate a number of things about your patient’s condition, including the category of codes and the phase of treatment. Although this coding logic might not offer you the comfort that alphabet soup once did, these letters of designation do have their place. In terms of ICD-10, Z is just as important as A. But unlike the ABC song, the letter Z doesn’t signify the end. In fact, it signifies the beginning for some rehab therapists—namely, those coding for aftercare. Here’s what you need to know about Z codes—no slurping required:
“Goodbye” to the V57 series
The V57 code series you once knew (and loved) is saying sayonara, as this series isn’t included in the ICD-10-CM code set. If you were to map every one of these V57 codes to a relevant ICD-10 code, you’d end up with one match: Z51.90, Encounter for other specified aftercare. According to the ICD-10 tabular list, this code isn’t able to stand on its own; you also must code for the condition requiring care. Coding for the underlying condition helps prove the medical necessity of your treatment. For more on coding for medical necessity, check out this blog post.
“Hello” to the Seventh Character
If you have the option of submitting a primary diagnosis code that contains a seventh character on your claim, you should take that route rather than selecting one of the aftercare codes. The seventh character indicates phase of treatment, but not all codes require—or allow for—this character. Most of the codes within the musculoskeletal chapter of the tabular list (chapter 13) don’t allow for seventh characters. That’s because most of these conditions result from a healed injury or are chronic in nature—so the phase of treatment is already implied. As for those codes that do require seventh characters (like the ones that appear in chapter 19, also known as the injury chapter): By selecting “D” as the seventh character, you’re indicating that the patient is in the healing and recovery phase of treatment. And if you’ve added a primary diagnosis code with a “D” in the seventh character position, there’s no need to submit an aftercare code, because you’ve already indicated that the patient is in the healing and recovery phase of treatment.
“Maybe” to Z Codes for Surgical Aftercare
Postoperative care aims to bring a patient back to his or her healthy level of function. If you’re specifically providing a patient with surgical aftercare treatment, ICD-10 has a few coding options. To give a couple of examples, you can use Z51.89, Encounter for other specified aftercare, or Z47.1, Aftercare following joint replacement surgery. According to the official ICD-10-CM guidelines for coding and reporting, “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.” That said, your clinical judgement and documentation will justify your code selection.
“Sometimes” to Singular Coding
If you’ve selected a Z code as your primary code, it doesn’t necessarily mean you should ditch any additional codes. If there are other codes that apply to your treatment and the patient’s situation, you should include them as well. In some cases, this might mean submitting multiple Z codes to more fully describe the patient’s situation. According to this ICD10 Monitor article, “Aftercare codes should be used in conjunction with other aftercare codes, diagnosis codes and/or other categories of Z-codes to provide better detail on the specifics of the aftercare encounter/visit, unless otherwise directed by the classification.”
One good example of this is in surgical aftercare for a joint replacement. As explained in this WebPT blog post: “If you were treating a patient who had a total knee replacement, you would want to submit Z47.1, Aftercare following joint replacement surgery, as well as ICD-10: Z96.651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant.” In this example, the patient received surgery for osteoarthritis relief. It’s assumed the patient is not seeking treatment for osteoarthritis, as he or she has undergone surgery to remedy this condition. Thus, you would use both Z codes to indicate the surgery as well as the joint replaced. For more information on this scenario, check out the blog post.
The use of aftercare codes might not be as cut and dried as you’d like to think. However, that doesn’t mean it needs to be a cause for concern. Just keep in mind that listing Z codes as primary codes should be a last resort. In fact, it may not be appropriate at all. If you have a code that more accurately describes why the patient is seeking therapy, apply that one. While ICD-10 coding might not be as enjoyable as singing your “ABCs” or chowing on some alphabet soup, I hope you’ll still find some satisfaction in knowing how—and when—to apply those oh-so-important letters.