The word “rehabilitation” implies restoration. In the rehab therapy space, that usually means restoring health—in other words, getting a patient back to his or her previous, healthy level of musculoskeletal function. So, in many cases, therapists see patients “after” they’ve experienced some type of disruptive event—like an injury, an illness, or a surgical procedure. Even so, therapists should only use ICD-10 aftercare codes to express patient diagnoses in a very select set of circumstances. Here are the most important tips to keep in mind regarding the use of aftercare codes in rehab therapy settings:

Breaking Bad Habits: The Modern PT’s Formula for Success - Regular BannerBreaking Bad Habits: The Modern PT’s Formula for Success - Small Banner

1. The V57 series of ICD-9 aftercare codes will not exist within ICD-10.

As this blog post explains, "A simple mapping of the V57 series of codes found in ICD-9-CM over to ICD-10-CM is not possible, as codes that duplicate the V57 series currently are not included in ICD-10-CM classification." In fact, this resource states that all V57 codes map to a single code in ICD-10: Z51.89, Encounter for other specified aftercare. And if you look up that code in the ICD-10 tabular list, you’ll see note that instructs you to “code also condition requiring care." In other words, you should not submit Z51.89 as a patient’s sole diagnosis—if you can help it—because on its own, this code might not adequately support the medical necessity of therapy treatment. Thus, using it as a primary diagnosis code could lead to claim denials. For more on the importance of coding for medical necessity, check out this blog post.

2. You should not use aftercare Z codes if the patient’s primary diagnosis code includes a seventh character that designates the encounter type.

ICD-10 introduced the seventh character to streamline the way providers denote different encounter types—namely, those involving active treatment versus those involving subsequent care. However, not all ICD-10 diagnosis codes include the option to add a seventh character. For example, most of the codes contained in chapter 13 of the tabular list (a.k.a. the musculoskeletal chapter) do not allow for seventh characters. And that makes sense considering that most of those codes represent conditions—including bone, joint, or muscle conditions that are recurrent or resulting from a healed injury—for which therapy treatment does progress in the same way it does for acute injuries.

Codes for acute injuries (mainly found in chapter 19) and fractures, however, do allow for seventh characters. And when you use the seventh character “D,” you are denoting that the patient is in the healing/recovery phase of his or her treatment. Essentially, you are indicating that the patient is receiving aftercare for the injury. Thus, you should not use aftercare codes in conjunction with injury codes, because doing so would be redundant.

3. You can use Z codes to code for surgical aftercare.

In this ICD10 Monitor article, Lauri Gray, RHIT, CPC, writes, “Aftercare visit codes cover situations occurring when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or care for the long-term consequences of the disease.” Post-op care falls into that bucket when the condition that precipitated the surgery no longer exists, but the patient still requires therapy care to return to a healthy level of function. For those instances, ICD-10 provides a few coding options, including Z51.89, Encounter for other specified aftercare, and Z47.1, Aftercare following joint replacement surgery.

Have more questions about ICD-10?

We’ve got you covered. Enter your email address below, and we’ll send you a copy of the One ICD-10 FAQ to Rule Them All.

Please enable JavaScript to submit form.

4. A single aftercare code might not be enough.

In situations where it’s appropriate to use Z codes, “aftercare codes are generally the first listed diagnosis,” Gray writes. However, that doesn’t mean the Z code should be the only diagnosis code listed for that patient. In fact, you should submit secondary codes—including other Z codes—when applicable in order to fully describe the patient’s situation in the most specific way possible: “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,” Gray states. In cases involving joint replacement surgery, one of those secondary codes should indicate which joint was replaced.

For example, 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 Z96.651 (to indicate that the joint replaced was the knee). To take that example a step further, let’s say the patient was receiving physical therapy care for gait abnormality following a total knee replacement of the right knee due to osteoarthritis in that knee. Let’s also assume that, as a result of the surgery, the patient is no longer suffering from osteoarthritis. The appropriate codes for this scenario, according to this presentation, would be:

  • ICD-10: Z47.1, aftercare following surgery for joint replacement
  • ICD-10: Z96.651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant
  • ICD-10: R26.9 Abnormality, gait

If the line between acceptable and unacceptable uses of aftercare codes still seems a bit fuzzy, just remember that in most cases, you should only use aftercare codes if there’s no other way for you to express that a patient is on the “after” side of an aforementioned “before-and-after” event. So, go ahead and use an aftercare code “after” you’ve exhausted all other coding options. (See what I did there?)


Got an aftercare question? Leave it in the comment section below, and I’ll do my best to get you an answer.

  • The Final 48: Your Guide to ICD-10 Transition Day Image

    articleAug 31, 2015 | 5 min. read

    The Final 48: Your Guide to ICD-10 Transition Day

    For law enforcement officials, the 48 hours immediately following a crime are the most crucial. Why? Because if they haven’t found any leads, identified any suspects, or made any arrests by the time the two-day clock expires, their chances of cracking the case—and, in some cases, saving lives—dwindle significantly. And while ICD-10 isn’t exactly a life-or-death situation, those HIPAA-covered providers making the switch will be up against a similar make-it-or-break-it timeframe. The only difference—besides the whole crime …

  • A Farewell Ode to ICD-9 Image

    articleSep 30, 2015 | 2 min. read

    A Farewell Ode to ICD-9

    As the hours count down It’s hard to believe That we’ve finally made it To ICD-10 Eve Our journey to get here Hasn’t been without strife As the US has clung To ICD-9 for dear life Letting go can be hard And change can be tough But in the modern medical world ICD-9 just isn’t enough Unlike a fine wine That gets better with time ICD-9 has aged poorly— It’s way past its prime Sure, we’ll always …

  • One ICD-10 FAQ to Rule Them All Image

    downloadNov 25, 2015

    One ICD-10 FAQ to Rule Them All

    The transition to ICD-10 was an unexpected journey for many healthcare providers—and making the switch was no easy quest. That’s why we traveled far over the Misty Mountains cold—and to dungeons deep and caverns old—to gather the answers to your most frequently asked ICD-10 questions.   Now, it’s time to head to the Shire, eat second breakfast, and make your coding concerns disappear. To go there (and back again), download the One ICD-10 FAQ to Rule Them …

  • What’s Your ICD-10 IQ? [Edit] Image

    articleAug 10, 2015 | 1 min. read

    What’s Your ICD-10 IQ? [Edit]

    For months, we’ve gone on and on about ICD-10 testing: testing your coding processes, testing your software, and testing with your payers. Now, with under two months to go before the transition date, it’s time to test one more very important factor: yourself. After all, no matter how sophisticated your systems and software are, critical thinking—and more importantly, clinical judgment—will make or break your ICD-10 success.   Think you’re an ICD-10 Einstein? Take our quiz to prove …

  • The PT's Guide to Billing Image

    downloadJun 7, 2016

    The PT's Guide to Billing

    When it comes to physical therapy billing, you have to know your stuff—because even the simplest mistakes can cause denials. Of course, knowing billing backwards and forwards doesn’t have to be complicated. That’s why we created a comprehensive billing resource specifically for PTs. Take the guesswork out of billing. Enter your email address below, and we’ll send your free guide.

  • In a Multiple-Code State of Mind: Why One ICD-10 Code Might Not be Enough Image

    articleSep 17, 2015 | 6 min. read

    In a Multiple-Code State of Mind: Why One ICD-10 Code Might Not be Enough

    You’ve probably heard the saying, “A picture is worth a thousand words.” The same logic applies to ICD-10 coding—albeit in a less extreme manner. While you probably won’t need a thousand ICD-10 codes to paint a complete picture of a patient’s diagnosis, there’s a good chance you’ll need more than one—and for many rehab therapists, that represents a huge departure from the coding status quo. With that in mind, here are a few tips for using a …

  • ICD-10 FAQ Part 4 Image

    articleNov 3, 2015 | 5 min. read

    ICD-10 FAQ Part 4

    Like the many Land Before Time sequels, the versions of our ICD-10 FAQ keep on-a-comin’. But—unlike those beloved dinosaur tales—I don’t anticipate 12 more versions (plus a TV series) will be necessary to cover what’s to come with ICD-10. Still, the questions continue to roll in—albeit a bit slower than they did a couple of months ago. However, most of the inquiries we’ve received in recent weeks have been super specific. That’s why, our most recent webinar—the …

  • 7 Scoops of 7th Character Sage Image

    articleAug 5, 2015 | 7 min. read

    7 Scoops of 7th Character Sage

    Seven dwarves; seven world wonders; 7-Up. These are all totally non-threatening—some might even say smile-inducing—associations with the number seven. ICD-10’s seventh character, on the other hand, has caused a lot of frowns—or, at the very least, furrowed brows—among those in the healthcare community. And that’s especially true for physical therapists. Here, I’ve compiled a list of seven seventh-character must-knows: 1. There’s no ICD-9 equivalent of the seventh character. ICD-9 caps its codes at five characters, meaning seventh …

  • ICD-10 and Your Claims: 7 Essential Must-Knows Image

    articleSep 14, 2015 | 7 min. read

    ICD-10 and Your Claims: 7 Essential Must-Knows

    As we’ve suggested in previous posts , one of the best ways to ensure your practice covers all of its ICD-10 prep work bases is to audit your processes and workflows. By doing so, you’ll identify all the ways you and your staff currently use and interact with ICD-9 codes. If you’ve done that, you’ve no doubt pinpointed one of the largest—and most obvious—ICD-9 touchpoints: your claims. Then, you probably asked yourself (or the almighty Google), “How …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.