New sepsis aftercare code Z51.A: How would you assign to this clinical scenario?

By Joanne Wilson, RN, ADN, CCDS, Senior Director, Solutions

We have a new ICD-10-CM code to bill sepsis aftercare. Effective October 1, 2024, coders can report Z51.A: Encounter for Sepsis Aftercare.

Z51.A was long in the making, needed to fill a gap in post-sepsis care. Sepsis is nasty and can result in long-term health complications. Something was needed to capture the unique needs of sepsis survivors, helping to ensure they receive the necessary support and interventions, and support quality metrics associated with long-term outcomes for survivors.

But using it correctly takes a little finesse. Let’s take a look at a clinical scenario and see how (and if) it applies.

Scenario

A patient returns to the infectious disease clinic for a three-month follow-up visit. The patient had been discharged from the hospital after being treated for sepsis with shock, acute respiratory failure, and pneumonia and was sent home with IV antibiotics for eight weeks. The patient is no longer receiving any treatment and has no signs or symptoms of infection.

The ID provider assigns the following codes for this clinic encounter:

• Sepsis (A41.9)
• Severe Sepsis (R65.20)
• Listeria Bacteremia (A32.9, R78.81)
• Disseminated Coccidioidomycosis (B38.7)
• Hospital Discharge Follow-up (Z09)

In this scenario, code Z51.A encounter for sepsis aftercare wouldn’t be assigned. 🤔 Instead, here’s the correct code assignment:

• Encounters for follow-up examination after completed treatment for conditions other than malignant neoplasm (Z09) {Medical surveillance following completed treatment}
• Personal history of other infectious parasitic diseases (Z86.19)

When to use Z51.A

• Assign as the principal diagnosis when the primary reason for the encounter is aftercare related to sepsis recovery.
• Include codes for any residual conditions or complications from sepsis as secondary diagnoses (e.g., organ dysfunction, mobility issues, or cognitive impairments).

When Not to Use Z51.A

• Do not use during active treatment of sepsis or its acute complications. Instead, code the active condition (e.g., A41.x for sepsis or R65.2 for severe sepsis).
• Avoid using Z51.A for routine follow-up visits unrelated to sepsis recovery
• Z51.A has an excludes1 note, indicating it should not be used with follow-up examination after treatment (Z08-Z09)

Per ICD-10-CM Official Guidelines for Coding and Reporting FY 2025:

• Section I.21.c.7, Aftercare codes are assigned “when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or from long-term consequences of the disease.”
• Section I.21.c.8, Follow-up codes are assigned “to explain continuing surveillance following completed treatment of a disease. They imply that the condition has been fully treated and no longer exists. Follow-up codes should not be confused with aftercare codes, or injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition or its sequela.

Read more about Z51.A here: https://www.norwood.com/new-sepsis-aftercare-code-fills-needed-gap-in-long-term-care-rendered-to-recovering-patients

Questions? Contact me

Have a question about this article? Need help with sepsis coding, or a claims review for your organization? Contact me at joanne@norwood.com