Don't miss this tip from the coding guidelines.
You’re caring for a patient following placement of an inferior vena cava (IVC) filter that will help manage his deep vein thrombosis (DVT). How do you decide which code should be sequenced first?
Look to the focus of care for this patient to determine which code must be first listed when you’re providing care following surgery.
Hint: Aftercare codes don’t always need to come first.
For example: Your new patient requires care for his chronic DVT in his right thigh following a procedure for placement of an inferior vena cava (IVC) filter. An IVC filter is a device that helps stop DVTs from reaching the lungs. You’ll also be providing care for the incision site.
For this patient, list I82.5Y1 (Chronic embolism and thrombosis of unspecified deep veins of right proximal lower extremity) in M1021. Then assign Z48.812 (Encounter for surgical aftercare following surgery on the circulatory system) as an additional code in M1023.
Your patient’s DVT is the focus of care in this scenario, so I82.5Y1 is your first-listed code.
Next, you can report care of the incision site with a surgical aftercare code (Z48.812). Surgical aftercare doesn’t have to be the focus of care. The coding guidelines stipulate that “an aftercare code may be used as an additional code when some type of aftercare is provided in addition to the reason for admission and no diagnosis code is applicable.” [I.C.21.c.7]
You also may want to use additional codes as appropriate, such as Z79.01 (Long term (current) use of anticoagulants) if the patient is taking anticoagulants, Z51.81 (Encounter for therapeutic drug level monitoring) if the agency is monitoring PT/INRs, and Z95.828 (Presence of other vascular implants and grafts) for the presence of the filter, for a patient coming to home health following the placement of an IVC filter.