Question:
Cherie Barth:
Can you please explain when a medication should be Z-coded for long-term use? I cannot find any clear guidelines on when we would document l/t use of aspirin vs. meds for HTN, COPD, etc. Is there a length of time that should pass before a medicine qualifies as "long term?"
Answer:
Lori Woods:
Z codes in ICD-10 are the same as V codes in ICD-9
1. What are V codes?
V codes (codes V01–V91) are used to describe encounters with circumstances other than disease or injury. V codes are used either as a first listed (primary) or contributing (secondary) code depending on the situation. There are four primary situations for which V codes are used:
1) A person who is not currently sick or injured encounters the healthcare system for a specific reason (e.g., exposure to an infectious disease).
2) A person with a resolving injury/disease or a chronic condition requires aftercare specifically for that condition (e.g., suture removal, dressing change).
3) Circumstances or problems influence a person's health status, but are not themselves a current illness or injury (e.g., asymptomatic HIV status).
4) Newborns, to indicate birth status.
2. Can V codes be used as a primary diagnosis?
Yes, unless otherwise specified in the code descriptor, V codes may be used as the primary diagnosis. Some V codes are required to be used as primary diagnosis, but only a few of these codes apply in the ED setting. (e.g. V70.4 Examination for medico-legal reasons, V71.x Observation and evaluation for suspected conditions not found).
Example: A patient comes to the ED after finding a bat in the tent while camping. There is no obvious injury. In this case the primary diagnosis would be V01.5 Contact with or exposure to rabies.
Example: You deliver a liveborn child in the ED and perform an MSE on the newborn. In this case the primary diagnosis would be V30.00 Single liveborn, Born in hospital, delivered without mention of cesarean delivery or V30.1 if delivered in the patient’s car in the parking lot.
A V code may only be used as a contributing (secondary) diagnosis when it has a “code first” note with the description. Many commercial ICD books may note some V codes are an “unacceptable primary diagnosis” or can be a "secondary diagnosis only." This notation only applies to these codes for their use as a primary inpatient diagnosis and does not affect their use in the outpatient setting.
3. Are there times when I can’t use a V code for a primary diagnosis?
Yes. This is payer dependent. For example, Medicare does not allow V codes as the primary diagnosis for Hospice claims.
4. Are V codes mandatory?
The Official Coding Guidelines do not differentiate the use of V codes from that of other codes (except E codes). V codes will most often be used to describe an encounter for testing or to identify a potential risk. They should not be used, however, when the diagnosis code includes the condition provided by the status/V code.
Example 1: A patient with a ventricular-peritoneal shunt present to the ED with a vomiting. After an appropriate evaluation it is determined that there is no shunt malfunction and that the vomiting was most likely due to a viral process. In this case the primary diagnosis would be 787.03 Vomiting. A secondary diagnosis of V45.2, presence of cerebrospinal fluid drainage device, would help support medical necessity for a workup to determine whether there was a shunt malfunction.
Example 2: A patient presents with complications associated with heart transplant. Code V42.1, Heart transplant status, should not be used with code 996.83, Complications of transplanted heart. The status code does not provide additional information. The complication code indicates that the patient is a heart transplant patient.
Additional V code information may be found in section I-18 of the 2011 Official ICD-9-CM Coding Guidelines.
Z codes are the same as V codes in ICD-9. V58.6x Long-term (current) drug use Codes from this subcategory indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 69 of 107 medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead. Assign a code from subcategory V58.6, Long-term (current) drug use, if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from subcategory V58.6 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis)
Cherie Barth:
Can you please explain when a medication should be Z-coded for long-term use? I cannot find any clear guidelines on when we would document l/t use of aspirin vs. meds for HTN, COPD, etc. Is there a length of time that should pass before a medicine qualifies as "long term?"
Answer:
Lori Woods:
Z codes in ICD-10 are the same as V codes in ICD-9
1. What are V codes?
V codes (codes V01–V91) are used to describe encounters with circumstances other than disease or injury. V codes are used either as a first listed (primary) or contributing (secondary) code depending on the situation. There are four primary situations for which V codes are used:
1) A person who is not currently sick or injured encounters the healthcare system for a specific reason (e.g., exposure to an infectious disease).
2) A person with a resolving injury/disease or a chronic condition requires aftercare specifically for that condition (e.g., suture removal, dressing change).
3) Circumstances or problems influence a person's health status, but are not themselves a current illness or injury (e.g., asymptomatic HIV status).
4) Newborns, to indicate birth status.
2. Can V codes be used as a primary diagnosis?
Yes, unless otherwise specified in the code descriptor, V codes may be used as the primary diagnosis. Some V codes are required to be used as primary diagnosis, but only a few of these codes apply in the ED setting. (e.g. V70.4 Examination for medico-legal reasons, V71.x Observation and evaluation for suspected conditions not found).
Example: A patient comes to the ED after finding a bat in the tent while camping. There is no obvious injury. In this case the primary diagnosis would be V01.5 Contact with or exposure to rabies.
Example: You deliver a liveborn child in the ED and perform an MSE on the newborn. In this case the primary diagnosis would be V30.00 Single liveborn, Born in hospital, delivered without mention of cesarean delivery or V30.1 if delivered in the patient’s car in the parking lot.
A V code may only be used as a contributing (secondary) diagnosis when it has a “code first” note with the description. Many commercial ICD books may note some V codes are an “unacceptable primary diagnosis” or can be a "secondary diagnosis only." This notation only applies to these codes for their use as a primary inpatient diagnosis and does not affect their use in the outpatient setting.
3. Are there times when I can’t use a V code for a primary diagnosis?
Yes. This is payer dependent. For example, Medicare does not allow V codes as the primary diagnosis for Hospice claims.
4. Are V codes mandatory?
The Official Coding Guidelines do not differentiate the use of V codes from that of other codes (except E codes). V codes will most often be used to describe an encounter for testing or to identify a potential risk. They should not be used, however, when the diagnosis code includes the condition provided by the status/V code.
Example 1: A patient with a ventricular-peritoneal shunt present to the ED with a vomiting. After an appropriate evaluation it is determined that there is no shunt malfunction and that the vomiting was most likely due to a viral process. In this case the primary diagnosis would be 787.03 Vomiting. A secondary diagnosis of V45.2, presence of cerebrospinal fluid drainage device, would help support medical necessity for a workup to determine whether there was a shunt malfunction.
Example 2: A patient presents with complications associated with heart transplant. Code V42.1, Heart transplant status, should not be used with code 996.83, Complications of transplanted heart. The status code does not provide additional information. The complication code indicates that the patient is a heart transplant patient.
Additional V code information may be found in section I-18 of the 2011 Official ICD-9-CM Coding Guidelines.
Z codes are the same as V codes in ICD-9. V58.6x Long-term (current) drug use Codes from this subcategory indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 69 of 107 medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead. Assign a code from subcategory V58.6, Long-term (current) drug use, if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from subcategory V58.6 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis)