This article addresses the CPT/HCPCS and ICD-10 codes associated with L37228 Wound Care policy.
ICD-10-CM Code for Encounter for surgical aftercare following surgery on specified body systems Z48. 81.
It is also acceptable to put Z48. 00 in the primary spot when the coding sequence or non-surgical wound you are coding as primary does not fall into the wound primary clinical grouping.
998.83 - Non-healing surgical wound is a topic covered in the ICD-10-CM.
Use Z codes to code for surgical aftercare. Z47. 89, Encounter for other orthopedic aftercare, and.
Follow-up. The difference between aftercare and follow-up is the type of care the physician renders. Aftercare implies the physician is providing related treatment for the patient after a surgery or procedure. Follow-up, on the other hand, is surveillance of the patient to make sure all is going well.
Dressings applied to the wound are part of the services for CPT codes 97597, 97598 and 97602 and they may not be billed separately. It is not appropriate to report CPT code 97602 in addition to CPT code 97597 and/or 97598 for wound care performed on the same wound on the same date of service.
97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (for example, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.
Wound debridement codes (not associated with fractures) are reported with CPT codes 11042-11047. Wound debridements are reported by the depth of tissue that is removed and the surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers.
A non-healing wound, such as an ulcer, is not coded with an injury code beginning with the letter S. Four common codes are L97-, “non-pressure ulcers”; L89-, “pressure ulcers”; I83-, “varicose veins with ulcers”; and I70.
ICD-10-CM is very specific and many easy-to-adapt codes such as non-healing wounds have been replaced by dedicated categories. Use T81. 89X (A, D, or S) along with a secondary code for the complication/manifestation.
Other complications of procedures, not elsewhere classifiedICD-10 code T81. 89XA for Other complications of procedures, not elsewhere classified, initial encounter is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes .
Z48. 0 - Encounter for attention to dressings, sutures and drains | ICD-10-CM.
Presence of other specified devices The 2022 edition of ICD-10-CM Z97. 8 became effective on October 1, 2021. This is the American ICD-10-CM version of Z97.
K91.5ICD-10 code K91. 5 for Postcholecystectomy syndrome is a medical classification as listed by WHO under the range - Diseases of the digestive system .
K65. 1 - Peritoneal abscess | ICD-10-CM.
Aftercare codes are found in categories Z42-Z49 and Z51. Aftercare is one of the 16 types of Z-codes covered in the 2012 ICD-10-CM Official Guidelines and Reporting. 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.
Aftercare for injuries is reported with a V-code in ICD-9-CM. However, aftercare of injuries in ICD-10-CM is captured with the seventh character “D,” specifically denoting routine care following most injuries. For fractures, additional seventh characters for subsequent encounters apply, depending on whether the fracture is open or closed and whether the healing is routine or delayed, with nonunion or malunion.
Aftercare following explantation of a joint prosthesis is reported with a code from category Z47, denoting orthopedic aftercare. Aftercare following explantation of a joint prosthesis (Z47.3-) may be reported for a staged procedure or an encounter for evaluation of planned insertion of a new joint prosthesis following prior explantation of a joint prosthesis. In ICD-10-CM, aftercare for explantation of a joint prosthesis is specific to site.
The codes for factors influencing health and contact with health services represent reasons for encounters. In ICD-10-CM, these codes are located in Chapter 21 and have the initial alpha character of “Z,” so codes in this chapter eventually may be referred to as “Z-codes” (just as the same supplementary codes in ICD-9-CM were referred to as “V-codes”). While code descriptions in Chapter 21, such as aftercare, may appear to denote descriptions of services or procedures, they are not procedure codes. These codes represent the reason for the encounter, service or visit, and the procedure must be reported with the appropriate procedure code.
Reason for encounter: Aftercare for traumatic fracture is reported with code S82.224D, Nondisplaced transverse fracture of shaft of right tibia, subsequent encounter for closed fracture with routine healing.
When the reason for an encounter is aftercare following a procedure or injury, the 2012 ICD-10-CM Official Guidelines and Reporting should be consulted to ensure that the correct code is assigned. Codes for reporting most types of aftercare are found in Chapter 21. However, aftercare related to injuries is reported with codes from Chapter 19, using seventh-character extensions to identify the service as aftercare.
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.
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.
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:
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:
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.
ICD-10 introduced the seventh character to streamline the way providers denote different encounter types—namely, those in volving 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.
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 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.
A therapist acting within their scope of practice and licensure performing active wound care management services must add the appropriate therapy modifier (GN, GO, GP) to the CPT code billed. In addition the therapy Revenue Code must be submitted for that service. If a non-therapist performs the service, no therapy modifiers are used and a non-therapy Revenue Code must be submitted for the service. Please see MM10176 for more information.
Codes 97602, 97605, 97606, 97607 and 97608 include the application of and the removal of any protective or bulk dressings. However, if only a dressing change is performed without any active wound procedure as described by these debridement codes, these debridement codes should not be reported.
The CPT code selected should reflect the level of debrided tissue (e.g., skin, subcutaneous tissue, muscle and/or bone), not the extent, depth, or grade of the ulcer or wound.
Dressings applied to the wound are part of the service for CPT codes 11000-11012 and 11042-11047 and may not be billed separately.
Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately reportable. However, debridement of tissue at the site of an open fracture or dislocation may be reported separately with CPT codes 11010-11012.