Patients taking Plaquenil (hydroxychloroquine, Sanofi-Aventis) on a long-term basis may leave you scratching your head when it comes to coding the patient encounters. Although coding for long-term medications is not a difficult process, it often involves communicating with other physicians or specialists to obtain accurate information. While this clinical example focuses on Plaquenil, the concept works for any long-term medication.
ICD-10 Classifications
The ICD-10 section that covers long-term drug therapy is Z79, with many subsections and specific diagnosis codes.
Because Plaquenil does not have its own specific category, clinicians should use Z79.899—Other Long Term (Current) Drug Therapy. But getting the right code is just one step in the process of correctly documenting the encounter.
ICD-10 Codes for Long-term Therapies | |
| Code | Long-term (current) use of |
| V – Valid For Claim Submission | |
| Z79.01 | anticoagulants |
| Z79.02 | antithrombotics/antiplatelets |
| Z79.1 | NSAIDs |
| Z79.2 | antibiotics |
| Z79.3 | hormonal contraceptives |
| Z79.4 | insulin |
| Z79.51 | inhaled steroids |
| Z79.52 | systemic steroids |
| Z79.810 | selective estrogen receptor modulators |
| Z79.811 | aromatase inhibitors |
| Z79.818 | other agents affecting estrogen receptors and estrogen levels |
| Z79.82 | aspirin |
| Z79.83 | bisphosphonates |
| Z79.84 | oral hypoglycemic drugs |
| Z79.891 | opiate analgesic |
| Z79.899 | other drug therapy |
| H – Not Valid for Claim Submission | |
| Z79 | drug therapy |
| Z79.0 | anticoagulants and antithrombotics/antiplatelets |
| Z79.5 | steroids |
| Z79.8 | other drug therapy |
| Z79.81 | agents affecting estrogen receptors and estrogen levels |
| Z79.89 | other drug therapy |
Code the Condition
When coding for these individuals, it is important to understand the mechanism in place. The patient is taking a long-term medication for a specific systemic condition, such as rheumatoid arthritis (RA), so the first step is coding for that. This is where communication with other physicians is paramount. You and the patient’s other providers need to remain consistent with the ICD-10 code used to describe the condition for which the patient is being treated. Once you know the primary systemic condition, you can code the medication use and any adverse effects that require further attention.
Example: Plaquenil
Here’s the coding for a patient taking Plaquenil for RA:
1. Report M06.08 for RA, other, or M06.9 for RA, unspecified (always report the systemic disease state first).
2. Report Z79.899 for Plaquenil use for RA.
3. Always report both. Link to both, and if the carrier does not pay on the Z code, link to the M code first (or only link to the M code).
4. If maculopathy is present, report the adverse effect of the hydroxychloroquine as well:
T37.2x5A: Adverse effect of anti-malarials and drugs acting on other blood protozoa, initial encounter.
T37.2x5D: Adverse effect of anti-malarials and drugs acting on other blood protozoa, subsequent encounter.
T37.2x5S: Adverse effect of anti-malarials and drugs acting on other blood protozoa, sequela.
Understanding what you are clinically evaluating in a patient taking long-term medications and following the basic ICD-10 rules will help you be quite successful in caring for these patients and adding a valuable care component to your practice.
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