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Replacement ICD/pacemaker status codes

sonya Posted Tue 22nd of January, 2019 19:18:42 PM
As you are probably aware, many ICD/pacers are placed and are not medically necessary per NCD 20.4. I was dinged on an audit for not appending a z45.6 to my corrected claim in an effort to get MEDICARE to consider covering the replacement device after they paid and recouped the money. I have NEVER had that diagnosis code on a device claim that is being replaced. Can you tell me if there should have been a Z code or status code on the corrected claim? The device was replaced due to replacement battery indicator and was up graded from a single to a dual lead. (which was mentioned due to L BBB) EF was from 2016 on a 2017 claim.
SuperCoder Answered Wed 23rd of January, 2019 06:58:22 AM

Hi Sonya,

Thank you for your question.

 

As per ICD-10 CM guidelines, Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.  Certain Z codes may only be used as first-listed or principal diagnosis.

Status Z codes may be used with aftercare Z codes to indicate the nature of the aftercare.  For example, code Z95.1, Presence of aortocoronary bypass graft, may be used with code Z48.812, Encounter for surgical aftercare following surgery on the circulatory system, to indicate the surgery for which the aftercare is being performed.

So, you can append the below suggested codes on your corrected claim.

Z45.010- Encounter for checking and testing of cardiac pacemaker pulse generator [battery]

              Encounter for replacing cardiac pacemaker pulse generator [battery]

Z95.0- Presence of cardiac pacemaker

 

Note: The code that you have suggested, i.e., z45.6 does not exist.

 

Hope it helps!

Thanks

sonya Posted Wed 23rd of January, 2019 19:09:35 PM
I'm so sorry, I meant to type z45.89 Adjustment and management of device
SuperCoder Answered Thu 24th of January, 2019 03:18:21 AM

The ICD-10 code (Z45.89) suggested by you indicates, Encounter for adjustment and management of other implanted devices. Since we have a more specific ICD-10 code available for cardiac pacemaker replacement, you can report the below mentioned ICD-10 codes in your corrected claim, i.e.

Z45.010-Encounter for checking and testing of cardiac pacemaker pulse generator [battery]

                Encounter for replacing cardiac pacemaker pulse generator [battery]

Z95.0-Presence of cardiac pacemaker

 

Hope it helps!

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