Make All the Right Moves by Following These Fall Coding Rules

Posted on 27 Jan, 2016 |comments_icon 0|By Chris Boucher
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Here’s why you might need a Z code for patients with a falling history.

When a patient presents to the physician after falling, you’ll need to consider several concepts in order to code correctly. A lot of the ICD-10 coding decisions will hinge on the patient’s falling history, and how well you know the new diagnosis codes.

Check out this advice for coding falls with ICD-10, and stick the landing on every claim you code.

Use R29.6 When Cause of Fall Not Yet Known

With ICD-10, you have R29.6 (Repeated falls). According to the ICD-10 guidelines, you would use R29.6 when a patient has recently fallen and the reason for the fall is being investigated. As the name implies, this code should be assigned when there is documentation that this isn’t just a situation of one isolated fall, but of multiple falls, says Stacie Norris, MBA, CPC, CCS-P, Director of Coding Quality Assurance for Zotec Partners in Durham, NC.

There is also another code available in ICD-10 for falls: Z91.81 (History of falling). This code is to be used when the patient has fallen before and is at risk for future falls.

However, you should not code Z91.81 as a primary diagnosis unless there is no other alternative, as this code is from the “Factors Influencing Health Status and Contact with Health Services,” similar to the V-code section from ICD-9. The diagnosis codes from this section are often denied by payers as not supporting the medical necessity for the claim, advises Norris. Note that there is an “Excludes 2 note” for code Z91.81 when using R29.6.

Hence, if the documentation supports it, both codes can be used together. In other words, one is not included in the other, as shown in the ICD-10 book:

R29.6 Repeat Falls

Falling

Tendency to fall

Excludes at risk for falling (Z91.81)

History of falling (Z91.81)

Choose Most Specific Dx the Documentation Supports

Finally, if you review the documentation and are in the unfortunate situation of having no other diagnosis (or sign/symptom) to use except “Fall,” then the appropriate ICD-10 code to use is Z04.3 (Encounter for examination and observation following other accident).

This is not a desirable coding situation because, as noted above, Z-codes are often denied and do not clearly reflect the acuity of the patient encounter.

For more information on all things related to ICD-10, consider a subscription to ICD-10 Coding Alert. Check it out at www.codinginstitute.com/newsletters/icd-10-coding-alert.html.

Author

Chris Boucher


Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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