Secondary Prevention, sequence of codes

June 12, 2017

Question:

I am having a dispute with an auditor regarding the sequencing of codes on an ICD device installed for secondary prevention. Patient suffered an acute MI followed by sudden cardiac death six days prior to the device install. I remembered a CMS rule stating that Z86.74 is a status code that is unacceptable as a principal diagnosis, so I coded I21.4, Z86.74. The auditor coded Z86.74, I21.4. This despite a company policy of "always coding to CMS rules". Does Z86.74 have to be in the principal position for the claim to be paid? Does the CMS "unacceptable" rule apply equally to IP and OP claims? See Definitions of Medicare Code Edits, ICD-10 Version, v 33 October 2015, page 217.

Question ID: 9461
Sign up for a membership to view the answer to this question.