Rehab therapists are restoration specialists. Not only do they work to restore musculoskeletal function to patients, they also restore patients’ confidence in their movement and functional capabilities. In most cases, therapists see patients after they’ve experienced some type of disruptive event—like an injury, an illness, or a surgical procedure. But that doesn’t mean therapists should exclusively use aftercare codes, as these specific ICD-10 codes apply only in very select circumstances.
So, when it comes to aftercare codes, rehab therapists should keep the following advice in mind.
If the patient’s primary diagnosis code includes a seventh character designating the encounter type, don’t use aftercare Z codes.
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, and 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, her, or their 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.
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Use Z codes to code for surgical aftercare.
When patients need continual care during a post-treatment healing or recovery phase—or when they require care for chronic symptoms that resulted from their original ailment—aftercare visit codes perfectly fit the bill. Z codes also apply to post-op care when the condition that precipitated the surgery no longer exists—but the patient still requires therapeutic care to return to a healthy level of function. In situations like these, ICD-10 provides a few coding options, including:
- Z47.89, Encounter for other orthopedic aftercare, and
- Z47.1, Aftercare following joint replacement surgery.
Remember, there are a number of orthopedic aftercare codes for specific surgeries—all of which you can find in the ICD-10 tabular list under Z47, Orthopedic aftercare.
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A single aftercare code might not be enough.
In situations where it’s appropriate to use Z codes, aftercare codes may be listed as the primary diagnosis—but 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 they can help you fully describe the patient’s situation in the most specific way possible.
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). Taking this one step further, let’s say the patient was receiving treatment 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?)
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