Author Topic: Dx Z41.8  (Read 1026 times)

Tameka79

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Dx Z41.8
« on: September 12, 2016, 08:01:42 AM »
Hi, I was wondering if someone could help me with this. 

I billed for a patient who had an abortion and is getting a Rhogam shot after the abortion.  I used CPT code 96372 and Dx Z41.8. In ICD-9 we used to use V07.2 (need for prophylactic immunotherapy), but the ICD-10 crosswalk points to Z41.8 and I can't find any other Dx code that would be approriate. 

Insurances are not paying because Z41.8 states (Encounter for other procedures for purposes other than remedying health state).

Does anyone have any advice as to what code I can use.  The patient is no longer pregnant, so I can not use the O36.XXXXX

Michele

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Re: Dx Z41.8
« Reply #1 on: September 12, 2016, 11:25:31 AM »
I did some research but I'm not coming up with anything.  The ICD10s are supposed to be more specific but I cannot find anything that replaces the V07.2.  Anybody else run into this?
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kristin

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Re: Dx Z41.8
« Reply #2 on: September 12, 2016, 07:56:41 PM »
I have never billed this, so don't really know, but would Z41.9 work? Are they considering the injection to be a surgical procedure, maybe? I would contact at least one of the insurances, and explain the situation, and see what they say. Can you find any medical policies/LCD's from any of the insurances that will help?

PMRNC

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Re: Dx Z41.8
« Reply #3 on: September 13, 2016, 12:55:46 PM »
Rhogam is an injection to correct a problem due to the RH Factor which is technically a poison... You would probably want to use ICD-10 T50.Z11
 
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RichardP

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Re: Dx Z41.8
« Reply #4 on: September 16, 2016, 11:58:22 AM »
If I remember correctly, in a normal pregnancy and delivery, Rhogam is administered at 28 weeks and then again within 72 hours after giving birth.

Technically speaking, the Rhogam administered after birth is given to a woman who is no longer pregnant - so I think you have some leeway with using the O36.XXXXX code for a woman who is no longer pregnant.

In technical, biological terms, what is the difference between a woman delivered of a fetus at term, or delivered of a fetus some time before term?  If the baby became distressed and needed to be delivered by C-Section at 6 months, and the woman needed Rhogam, would you argue that she doesn't qualify for the Rhogam?  I suggest that the same logic applies to abortion.  This may be crude, but delivery of a fetus by C-Section or by abortion is still delivery of a fetus, particularly in the case where the C-Section is performed to deliver a fetus that has expired in-utero.

Look at the wording attached to the 036 codes at this link.  Note that the focus is on the woman who is / has been pregnant.  This certainly applies in your case.

http://www.icd10data.com/ICD10CM/Codes/O00-O9A/O30-O48/O36-
O36.0190 = Maternal care for anti-D [Rh] antibodies, unspecified trimester

Or, simply pick the code that applies to the trimester in which the abortion was performed.

You could also consider Code Z88.8, Allergy status to other drugs, medicaments and biological substances status

http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z88-/Z88.8

The second phrase in the following ICD-10 category description suggest that this can be used for other than a Family History designation:  Persons with potential health hazards related to family and personal history and certain conditions influencing health status.

Or, perhaps the patient's insurance carrier could give you some guidance as to how to code so that they will pay.