Monday, November 15, 2021

Long-term Use of Medication

This month, “In the kNOW”, delves into the long-term use of medication codes found in the Z79 category.  Let’s begin by covering the Official Coding Guidelines that are applicable.

Guideline I.21.c.3 indicates that the Z79 category is reserved for identification of prescribed medication taken by a patient for the treatment or prevention of a condition.  This is further specified as being long-term treatment meaning that when a patient is prescribed a two-week course of an antibiotic for an infection, it is not appropriate to assign Z79.2 for long-term use of antibiotics.  The guideline provides additional clarity regarding extended use with these three groups:

Prophylactic administration-preventive measure such as an anticoagulant taken to reduce the risk of stroke  

Chronic condition treatment-ongoing medication taken to control a disease/condition such as Lisinopril for high blood pressure

Management of a disease requiring lengthy treatment-continuous treatment for disease management such as Tamoxifen for breast cancer.

That same guideline goes on to specify that these codes are not to be assigned for patients with drug addiction.  Instead, coding professionals are directed to assign the applicable code to capture drug use, abuse, or dependence as appropriate.  Also, keep in mind, that the long-term use of medication codes should not be used to capture detoxification medications or maintenance medications, such as methadone, that would be used to help prevent symptoms of withdrawal.   

Additional guidance on coding for long-term use of medications has been provided in various issues of Coding Clinic.  One area that was discussed addressed performance of therapeutic drug monitoring for patients on long-term medication.  Clarification, in that 3rd Quarter 2002 issue, indicated that the long-term use of medication code should be sequenced first, followed by the Z51.81 code for the monitoring.  This is supported in the Tabular Index with a “Code also” note under the Z79 category. 

A 1st Quarter 2021 Coding Clinic issued further guidance on long-term use of medication coding when they stated that medications prescribed to be used PRN (pro re nata or as needed) are not to be coded as long-term use in the Z79 category.  An example of this would be a patient who is prescribed Ativan to be taken PRN.  This is a periodic, isolated use of the medication, not a continuous, long-term usage.

In a 4th Quarter 2004 Coding Clinic, a question was asked if long-term use of medication (for example, aspirin) taken under the patient’s own initiative rather than actually prescribed by a physician also warranted coding with a long-term use Z-code.  The advice presented was yes.  In that scenario, it would be appropriate to code the long-term use of aspirin with Z79.82.

Two separate Coding Clinic editions issued guidance for specific medications.  The first was a 2nd Quarter 2020 issue which addressed Flonase stating that it is not considered either a systemic or inhaled steroid and should be coded to the Z79.899 for other long-term drug use monitoring.  The second was a 3rd Quarter 2020 issue on injectable GLP-1 receptor agonist drugs for diabetes, again stating that these should be coded as Z79.899.  A reminder that there are two additional codes available for long-term diabetic medications: Z79.4 for long-term use of insulin, and Z79.84 for long-term use of oral hypoglycemics.  For patients who may be on both insulin and oral hypoglycemics, an October 1, 2021 update to the Official Guidelines for Coding and Reporting at guideline I.C.4.a.3 now requires that both codes be assigned.  

Assignment of long-term use of medication codes may seem unnecessary, but aside from providing valuable information regarding the patient and their treatment, they can also impact reimbursement, especially in the outpatient setting.  For outpatient reimbursement, long-term use of medication codes may support medical necessity for testing services and resolve any edits that arise if not assigned. 

Coding professionals should be aware of the medications that have specific long-term use codes.  Anticoagulants (Coumadin), antiplatelets (Plavix), antibiotics (Amoxicillin), and selective estrogen receptor modulators {SERMs} (Tamoxifen) are some of the categories of medications which have Z79 codes.  Knowing which medications have these Z79 codes and what specific medications fall into each category will be beneficial when it is time to assign the codes.  

Now you are “In the kNOW”!!



About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.