Coding, Classification & Reimbursement

Labs and Z79.899

  • 1.  Labs and Z79.899

    Posted 10-18-2018 13:39
    Hello Everyone,

    When coding labs, someone is getting an ALT AST liver panel. The patient's med list says they take Simvastatin and the doctor documents they have hyperlipidemia, E78.5. Now, in order for me to use Z79.899 on this claim, must the doctor distinctly state in the note where they order the labs that the patient is on a long term medication?  As in, the doctor has the med in the patient's list, but does not talk about Simvastatin use in the office note.I assume that one could not just look at the med list and make the determination that Z79.899 could be abstracted from the med list alone as a coder. Any advice is appreciated,

    Thank you

    Robert Gorman
    Medical Records Specialist

  • 2.  RE: Labs and Z79.899

    Posted 10-18-2018 15:06

    I just wanted to follow this thread as well. I have used Z79.899 quite a bit for labs, over the last 6 months. As far as I know, none of the labs came back denied for the use of Z79.899. My biggest problems were in relation to the physican's use of Z00.00 exam codes on Medicare claims, when labs were ordered.

    Sarah Spencer, RHIT

  • 3.  RE: Labs and Z79.899

    Posted 10-20-2018 09:58
    Guidelines for Status Z codes state "Long-term (current) drug therapy-Codes from this category indicate a patient's continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for patients who have addictions to drugs. This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence) Assign the appropriate code for drug dependence instead.

    Assign a code from Z79 if the patient is receiving medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from category Z79 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis)"

    "Such as" is not all inclusive, so if the patient is receiving a Statin for the treatment of a chronic condition such as Hyperlipidemia,  it would be appropriate to assign Z79.899.

  • 4.  RE: Labs and Z79.899

    Posted 10-22-2018 13:33
    Edited by Barbara Hagan 10-22-2018 13:37
    ​Even though Z79.899 is sufficient to use for the lab, coders do not assign the diagnosis--the physician does this.  We can not forget the "medical necessity rule" for lab testing with CMS, etc.  CMS frowns on routine testing, and if a physician wants this done, he/she should document why it is needed.  (Review with your lab companies RE: "Medical Necessity Rule").  If our physicians order lab work, we either catch them when making rounds to clarify diagnosis, or we contact for phone order information to validate the diagnosis.
    Barbara Hagan
    Health Information Coordinator