Get to Know Aftercare Z Codes: Official Guidelines and Examples

Tue, May 30, 2017 --

ICD-10, Skill Sharpener

doctor caring for patient

How many of the 15 pages on Z codes have you read in the ICD-10-CM Official Guidelines for Coding and Reporting? More than a page is devoted to aftercare visit codes in Section I.C.21.c.7. Here’s a quick refresher on what you should know about aftercare coding, including the ICD-10 twist for injury codes.

The Basic Rule: Apply Aftercare Codes for Recovery Phase

The Official Guidelines (OGs) tell you to look at Z42-Z51 for aftercare Z codes. The general rule is that you use these codes when the patient has had initial treatment and the patient needs care for recovery or for consequences of the disease. Put another way, the codes aren’t appropriate for use when the disease is current or acute.

Remember the Antineoplastic Exception

Category Z51 may be included in the list of aftercare codes, but oncology coders know that they have to use Z51.0 (Encounter for antineoplastic radiation therapy) or a code from Z51.1- (Encounter for antineoplastic chemotherapy and immunotherapy) as the first-listed diagnosis when the patient encounter is for radiation, chemotherapy, or immunotherapy to treat a neoplasm. That means these codes apply when the disease is still active and under treatment.

Example: Suppose a patient presents for an antineoplastic chemotherapy infusion to treat a malignant neoplasm of the descending colon. Your first-listed code will be Z51.11 (Encounter for antineoplastic chemotherapy) followed by neoplasm code C18.6 (Malignant neoplasm of descending colon).

Caution: Not every case involving a neoplasm falls under the exception. For instance, a patient who has undergone successful surgery to remove a brain neoplasm may present for wound evaluation and a neurological check. In that case, Z48.3 (Aftercare following surgery for neoplasm) may be appropriate.

Steer Clear When Coding Injuries

Another exception to the “when to use aftercare Z codes” rule involves coding for aftercare of injuries. Instead of using Z codes you should turn to ICD-10’s infamous seventh characters to report subsequent care of an injury.

Example: You report T22.232D (Burn of second degree of left upper arm, subsequent encounter).

Combine and Sequence Those Z Codes Correctly

Reporting a Z code as the first-listed diagnosis is usually appropriate. But there are times the aftercare code may be secondary.

Example: The OGs offer the case of a patient undergoing colostomy closure during an admission for another condition. In this instance, Z43.3 (Encounter for attention to colostomy) may be an additional code.

Using multiple aftercare codes on the same claim may be appropriate, too. Base sequencing on the circumstances of the encounter, and be sure to check the code’s instructions to confirm the specific guidelines you need to apply, the OGs state.

Watch for: Including both a status Z code and an aftercare Z code on the claim also may be the right move.

Do: You may report Z95.1 (Presence of aortocoronary bypass graft) with Z48.812 (Encounter for surgical aftercare following surgery on the circulatory system) to provide more detail about the surgery involved, the OGs state.

Don’t: When the aftercare code gives the status, don’t add a status code. For instance, the OGs say not to use Z43.0 (Encounter for attention to tracheostomy) with Z93.0 (Tracheostomy status).

What About You?

Which Z codes do you use? Do you review the OGs each year?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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