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:
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.
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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.
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