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Resolved How does one code a recheck?

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Question:

nfort:

Patient returns for a recheck of the ear infection. The ear infection has resolved. I know one cannot code a resolved diagnosis, so how does one code this recheck?

Nina

Answer:

Paul A:

I think I have figured it out. I'm only just starting to look at ICD-10 so hopefully, Alicia or someone else can confirm.

I looked up History > Personal> Disease or disorder of > Ear (Z86.69) which is Personal History of Other Diseases of the nervous system and sense organs.

Z86 section said to code first Z09 which is: Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
It also said Medical surveillance following completed treatment
It then said Use additional code to identify any applicable history of disease code (Z86.- Z87.-)

I think this is correct Z09, Z86.69

Then again it might also be Z86.19 for the secondary which is a Personal history of other infectious and parasitic diseases BUT I think that is wrong as it says Conditions classifiable to A00-B89, B99, and Otitis Media don't fall under that.

Now that I look more deeply Z86.69 says Conditions classifiable to G00-G99, H00-H95 which is where Otitis Media falls
 
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