Wiki Z01.00 vs. Z13.5

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adpaugel

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Our charge entry clerk used Z13.5 for a Plaquenil screening for a Medicare patient. She neglected to use Z79.899.

I reopened the claim, removing Z13.5 and replacing it with Z79.899. Medicare's denial stated that Z13.5 was considered routine. My questions are:

If I would've sent out Z79.899 & Z13.5 together, would it have been understood that it was a toxicity screening? Or would Z13.5 still cause it to be considered routine?

What is the difference in Z13.5 and Z01.00/Z01.01? Is Z13.5 more on the medical side than routine?

Thanks for your input!
 
Need disease code

For plaquenil screening, you need two codes entered in this order:

1. Code for the disease for which they are taking the Plaquenil such as Lupus or RA

2. Z79.899 for the long term use of the medication
 
Screening is for a patient without the condition and currently without symptoms. If the patient is currently on the drug and you are monitoring the drug levels you use two codes, the Z51.81 followed by the Z79 code for the drug.
 
Sorry to disagree

I disagree with the last post. For years, when a patient who has RA or Lupus was seen for their annual eye exam, and they were also taking Plaquenil, the coding under ICD-9 was to code the disease code first and then the long term drug use code.

It is the same for ICD-10. Code for Lupus or RA first (there are several codes for each disease depending on level of involvement) and then put the code for the long term use of the medication, Z79.899.

If toxicity from the Plaquenil is noted, then you also put the code down for that from the Drugs and Chemicals table. That would go down third in order.

I believe that the code referenced by the previous poster would actually involve doing some sort of blood draw to actually measure the specific blood level of the medication. That's not the type of exam the original poster asked about.

Tom Cheezum, O.D., CPC
 
Coding clinics have several coding clinics on this. For drug monitoring you always use the code that states the reason for the encounter which is drug monitoring, and you use that code and for ICD10 it is Z51.81 first listed. You always code the reason for the encounter. several examples have been given and not all are blood draws.
 
Last edited:
Thank you very much for your replies. We are not monitoring drug levels, we are performing a medical eye exam to check for Plaquenil toxicity.

On that note though, do either of you have any input on Z13.5 vs Z01.00?
 
It is not screening for an eye disorder if the patient is taking the medication. If you are looking for toxicity then you are monitoring the drug levels.
 
Debra,
Sorry to keep disagreeing with you on this but I have been in practice 37 years as an OD and we always coded, and were paid, using the codes as I outlined. I attended several OD/ophthalmology specific coding seminars on ICD-10 over the past 2 years and every speaker said to code for those patients taking Plaquenil the way I outlined, including Corcoran Associates which is one of the more prominent coding consulting firms in the eye care field.

Tom Cheezum, O.D., CPC
 
Coding clinics which are the recognized authority in correct coding has always stated to code it as drug monitoring. I am only reporting what they have stated as the correct way to code. Every one has their own way to do something and coding is no different.
 
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