While diagnosis codes must be reported with the highest level of documented specificity, identifying the correct code for related conditions can be a challenge. To ensure accuracy, it is beneficial to review the "inclusion terms" found within the tabular index of the ICD-10-CM code set. Inclusion terms list specific conditions for which a code is appropriate; however, please note that these lists are not exhaustive.
Case Study: Z79.818 Code Z79.818 is designated for the long-term use of other agents affecting estrogen receptors and estrogen levels. While mapping to this code is straightforward for the long-term use of agents like fulvestrant or goserelin acetate, the inclusion terms clarify that this code also applies to:
• Megestrol acetate
• Gonadotropin-releasing hormone agonists
• Leuprolide acetate
For further guidance, utilize the CDC’s ICD-10-CM search tool and CMS Resources.
Be sure to bookmark the Coding and Reimbursement page to view more updates as they are added.