Z diagnosis codes are in

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Monday, June 26, 2017

The DME MACs have agreed to add several ICD-10 Z diagnosis codes to applicable sections of the Wheelchair Seating LCD.

That means complex rehab providers can submit claims with either S or Z diagnosis codes for positioning cushions for lower extremity amputations.

“This has been an oversight in policy since the policy was written,” said Martin Szmal, owner/president of The Mobility Consultants, who submitted a change request to the DME MACs in May. “This opens the door for providers and patients to get the cushions they need.”

Before now, only S diagnosis codes were included in the Group 3 and Group 4 diagnosis codes lists in the LCD. S and Z diagnosis codes differentiate between an acquired amputation (due to complications from diabetes, for example) and a traumatic amputation, respectively.

Szmal made the case that, although two sets of different codes are used to properly describe the manner of the amputation, the end result for the patient is the same.

“The associated issues (balance, posture, etc.) that follow these individuals with lower extremity amputations are the same regardless of how the amputation has come about,” he wrote in the change request.

Szmal made the request after digging into the denials of several of his provider clients.

“They wanted to know why their cushions were getting denied for these amputations,” he said. “In the documentation, Z codes were being used to identify the amputation and those weren’t listed in the policy.”

In their response, the DME MACs say they will include all but one Z diagnosis code in a future revision of the LCD.

“ICD-10 Z89.9 will not be added as it can describe conditions that would not correctly justify claim payment,” they wrote. “This code, being an unspecified one, could apply to upper extremity amputations, for instance, which would not be pertinent to this policy coverage material.”