# E/M level has a Z code as first listed diagnosis



## bethrice7 (Oct 19, 2015)

So I know that to code E/M diagnosis' they must be in the order of the plan in the H&P.  I have a doctor who put 1. Status Post total left hip arthroplasty 2. GERD 3. HTN 4. Hyperlipidemia.

I know I am suppose to code it as Z96.642, K21.9, I10, E78.5 However I also know that Z96.642 is not suppose to be listed first.  Help please, what should I do?? How do I code this correctly?

Thank you!


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## mitchellde (Oct 19, 2015)

What was documented as the reason for the visit.


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## bethrice7 (Oct 19, 2015)

The reason was documented as "Medical Management"- we were consulting on this patient after surgery.


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## mitchellde (Oct 19, 2015)

So you need an aftercare after surgery code.  The Z code selected by the provider is a status code, you need first listed the aftercare following joint replacement Z code.  
Also codes that go on the claim do not have to be in the order listed in the H&P.  The coder uses the narrative note and the coding guidelines to determine which codes go on a claim and which one is first listed.


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## bethrice7 (Oct 19, 2015)

Okay! Thank you!

Wait, are you sure for Evaluation and Management you don't need to code the diagnosis' in order they are on the H&P, Progress Note, Discharge etc? That is how I was taught to do it.


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## mitchellde (Oct 19, 2015)

The coder must put the codes in the correct order according to the documentation as the reason for the encounter and coding rules regarding first listed codes.


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## bethrice7 (Oct 20, 2015)

That makes more sense! Thank you so much!


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## rogerandpaula@mchsi.com (Oct 23, 2015)

I code for a family practice and the physicians see patients on rounds in the hospital. What aftercare code are we supposed to use when they see a patient status post hip replacement? I am so confused because that is the only diagnosis listed and it is a Z code. There are no specific codes for the PCP seeing the patient for aftercare only that apply. 

Please help!

Paula 
CPC-A


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## mitchellde (Oct 23, 2015)

Wouldn't the ortho surgeon be providing the follow for the hip replacement?  Are there other reason in the note as to why the provider was seeing the patient?


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