Radiology Coding Alert

Question: Our practice keeps receiving denials for using Z96.6- to code total joint post-op X-ray charges. The payer’s denial states there is a more appropriate diagnosis code for the procedure, but I’m unsure how much more specific we can be. Can you instruct me on which code(s) I should be using for an X-ray for a post-op visit from a total joint replacement case?

Florida Subscriber

Answer: Both your practice and the payer are correct with these procedures. Your primary diagnosis should be Z47.1 (Aftercare following joint replacement surgery). The notes following the descriptor instruct you to use an additional code to identify the joint (Z96.6-). So, you will follow code Z47.1 with Z96.6 (Presence of orthopedic joint implants) to reflect the total joint post-op X-rays.

Remember: The Z96.6- codes only indicate a status. You cannot use the codes alone to support the medical necessity or indicate the reason for the services.

Note: Code Z47.1 includes an Excludes1 of “aftercare for healing fracture-code to fracture with 7th character D.”