"I attended a coding seminar in Pennslyvania recently. There was information given that stated that when billing diabetic foot care that is covered under the E10 and E11 codes we must also include the appropriate Zcode. ie Z79.4 , Z79.84 , Z79.85. Is this correct and will we get denials? This is not in the LCD."
You are referring to ICD-10 coding instruction. What you wrote about E11- is correct. What you wrote about E10- is incorrect.
Instructions regarding how to remain compliant when using the ICD-10-CM code set are issued by the CDC and are publicly available for free here: https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf. As you can see, that is a 120 page document that contains guidelines for using the ICD-10-CM code set.
Section B.7 on page 13 of those guidelines explains the instruction "Use Additional Code" and it says "Use Additional Code" indicates that "a secondary code should be added, if known." This is not an option. It is an instruction.
The E08-, E09-, E11, and E13- codes all carry with them the instruction to:
Use additional code to identify control using:
The E10- codes do not have this instruction.
Therefore, whenever a E08-, E09-, E11, or E13- code is used, it should immediately be followed by the Z code that represents the medication(s) the patient uses for glycemic control. If the patient uses more than one of those, multiple Z codes should be used. If the patient does not use any of those, then none of those should be used. This direction does not change based on the service provided. This is not unique to routine foot care. This is not a routine foot care rule. It is an ICD-10 rule.
You asked if failure to code correctly will lead to denials. No one can know for sure what will lead to denials. While we cannot say for certain if incorrect coding *will* lead to denials, we can share that incorrect coding *can* lead to denials and audit failures and clawbacks.
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Certified Professional Coder
Certified Professional Medical Auditor
Lehrman Consulting, LLC