When does Z930 shift to Z430

jackietouch@aol.comjackietouch@aol.com
in Pediatrics

We had a visit from our auditor who initiated a lively discussion re: trach status versus attention to tracheostomy. Our practice has always been to capture Z930 as a secondary code on our patients with trachs and to use Z430 as a PDx for admissions for decannulation or other procedures related to the trach. Per the auditor, Z430 can be used as a secondary diagnosis if patient requires more than the expected amount of suctioning and care. And, sure enough, "toilet or cleansing of artificial openings" is an includes term and "artificial opening status only, without need for care (Z93-)" is an excludes 1 in I-10.

When I play with the encoder, I don't see any change in SOI/ROM between the two, but am wondering if any of you are capturing Z430 instead of Z930 on your patients who require more than the "ordinary amount" of suctioning/trach care. And, if you are capturing Z430 what criteria do you use to determine when to capture it instead of Z930?

Thanks in advance,

Jackie Touch, MSN,RN, CCM

CHOC Children's, Orange, CA


Comments

  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu

    Good topic Jackie!

    We have a situation similar to this today...wondering if you found out anything? We usually use Z930 on all of the trach kids unless they are coming if for reasons you stated. I am going to do some further research and was just wondering if you found out anything. SOI stays the same as you noted.

    Thanks,

    Jeff

  • jackietouch@aol.comjackietouch@aol.com
    edited July 2016
    Haven't found any concrete indicators for use of the Z430 versus Z930. We are still debating this topic. Things like suctioning frequency are so variable and, quite honestly, difficult to track down sometimes in nurses' and RTs' notes.

    Will update you as soon as I find anything.

    Jackie
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