Wiki Z79.899 Coding long term meds

[savannahq]

Hi everyone, I'm just looking for some additional clarification on billing Z79.899. I always thought you bill Z79.899 whenever a patient has a long term medication that does not have a more specific code (ie insulin, warfarin, metformin etc) However, I thought I remembered seeing somewhere that you don't bill for meds associated with HTN, CKD and other conditions where it is assumed most patients are on some type of medication. I work in primary care and have a lot of these patients so I just wanted some input.
Thanks!

 

[taylorking14]

I almost always add the Z79.899 if the patient is on any type of unlisted medications that is being used to continuously manage something. The only scenario that I don't typically add it would be if it states that the medication is on an as-needed basis. My rule of thumb is that it won't hurt to have it there, because if the patient is on long term medications, then the code can be justified.

 

[thomas7331]

Strictly speaking, per the ICD-10 guidance this code should only be assigned when it is relevant to the encounter, in other words that the patient is on a medication for conditions which "require or affect patient care treatment or management" at that particular encounter. So unless a diagnosis (such as diabetes) has instructions that require it, I generally would not assign a long-term drug use code simply because the patient is taking a medication unless the physician has also documented addressing the associated condition and made mention of the medication in their notes for that encounter. That's been my own interpretation of the guidance.

In my experience, though, facilities will make more use of these codes that physicians because they are actually administering medications during the patient's stay and want to be sure to capture and report this information, so they may have other internal guidance for their coders on the assignment of these codes.

 

[savannahq]

Strictly speaking, per the ICD-10 guidance this code should only be assigned when it is relevant to the encounter, in other words that the patient is on a medication for conditions which "require or affect patient care treatment or management" at that particular encounter. So unless a diagnosis (such as diabetes) has instructions that require it, I generally would not assign a long-term drug use code simply because the patient is taking a medication unless the physician has also documented addressing the associated condition and made mention of the medication in their notes for that encounter. That's been my own interpretation of the guidance.

In my experience, though, facilities will make more use of these codes that physicians because they are actually administering medications during the patient's stay and want to be sure to capture and report this information, so they may have other internal guidance for their coders on the assignment of these codes.

Okay this is kind of along the lines of what I was thinking as well. Are you thinking that when patients come in for med checks and their medications are refilled without change that constitutes Z79.899 or just when the dose is changed or frequency of the medication?

 

[thomas7331]

Okay this is kind of along the lines of what I was thinking as well. Are you thinking that when patients come in for med checks and their medications are refilled without change that constitutes Z79.899 or just when the dose is changed or frequency of the medication?

Honestly, I would only assign this code sparingly and in cases where, as I mentioned above, the provider is documenting that the long-term use of a medication is somehow impacting their treatment. I would not use it for every patient taking a medication for a chronic condition, or every time a medication dosage is changed - you're already capturing the condition itself with the primary code. I would ask myself: has the provider said something about the patient's long-term use of the drug that warrants another code in addition to the code for the condition itself that he or she is treating? This is a non-specific code which, in my opinion, adds no real value or useful information in most cases and it will just become extra administrative work to be putting it on so many encounters.

That's just my approach though. If it impacts your organization in some way or if your payer needs this for some reason or if your coding auditors are citing you errors for omitting it, then you may want to consider an internal policy as to when to use it. But if not, it's not a code I would use except for special cases in which it's somehow needed to represent an important piece of information that affects the level of care and that you want to capture in the coding.

I might just add that in close to 15 years of coding for various organizations, both physicians and hospitals, I think I can only recall a handful of instances where I've used this code. And in that all time, and considering that so many patients (especially in the hospitals) are on medications for chronic conditions, I've never once had a claim come back with a denial or an audit error for not having assigned this code.

 

[TThivierge]

Hi everyone, I'm just looking for some additional clarification on billing Z79.899. I always thought you bill Z79.899 whenever a patient has a long term medication that does not have a more specific code (ie insulin, warfarin, metformin etc) However, I thought I remembered seeing somewhere that you don't bill for meds associated with HTN, CKD and other conditions where it is assumed most patients are on some type of medication. I work in primary care and have a lot of these patients so I just wanted some input.
Thanks!

Hi Savannah
In the back of the ICD10 manual it gives list of dx blocks Z79 linked to certain type of medications. You know if pt. takes insulin or pills for treating DM & provider mentions it add dx Z79.4 or Z79.84, , Hormone Replacement or Estrogen meds, use dx Z79.890, Anticoagulant for heart conditions or blood clots use dx Z79.01, or pt. has Prostate or Breast Cancer use dx Z79.818. I hope this data helps you.
Lady T

 

[TThivierge]

Hi Savannah
I just wanted to mention of the patient is a smoker and has a illness of HTN, Respiratory,, Cardiac, Gastro, Eye or Ear problems add the Z72.0 or past history code Z87.891. These might be listed in the past history column of the med record. If doctor list in current assessments/dx for that visit add the Current Smoking use block dx F10. Also is the patient's doctor mentions pt taking meds of _______ for a certain disease you can add one of the blocks of Z79. Also in to taking insulin due to DM E11 or E11.8 dx blocks please add the insulin code Z79.4 or if taking pills to control the DM ds. use dx Z79.84. This should be listed in current notes for the day s treatment. If the doctor does not mention it you cannot assume taking certain meds for this or that condition/ds warrants a dx Z79.. You are correct on this fact. Here is something we do...if doc/provider states in his notes reviewed patients medication or did a medication reconciliation we add dx Z51.81 and if review lab test assign there is a dx Z71.2 code for this too. We add it at end of claim listed.
Have a great day!
Lady T