Coders may assign Z45.2 (Encounter for adjustment and management of vascular access device) as the principal diagnosis or the first listed secondary diagnosis code in order to be placed in the Complex Nursing clinical grouping under the Patient-Driven Groupings Model (PDGM), according to CMS.
 
This clarification comes as part of an email response sent by CMS to Lisa Selman-Holman, HCS-D, principal of Selman-Holman and Associates and the coding service CoDR - Coding Done Right in Denton, Texas. on Feb. 19.
 
Home health coders have been wary of reporting the code because Q3 2018 Coding Clinic guidance instructs “not to assign Z45.2 if the only service provided is administration of intravenous therapy.” Instead, Coding Clinic said to only code the condition being treated when home health is providing the medication as well as managing the device.
 
According to CMS’ email response, the home health grouper also will look for the presence of Z45.2 as a first-reported secondary diagnosis and, if found, would group into the Complex Nursing clinical group.
 
“The reasoning for looking at the first secondary diagnosis for Z45.2 was to ensure that the complexity of services inherent with a patient who has an IV or is receiving IV therapy was captured for the clinical group assignment under the PDGM in the event that the primary reason for home health services is for IV therapy or management of a patient with an IV line,” CMS notes in the email response.
 
As stated in the CY2020 final rule, CMS reminds that they will continue to evaluate ICD-10 diagnoses and their clinical group assignments each year to determine if any changes are required.
 
“While we recommend adherence to the coding guidelines, we recognize that there may be changes along the way to those guidelines that may warrant some modifications to the clinical group assignments under the PDGM case-mix model,” CMS says.
 
Selman-Holman sent a follow-up email to CMS asking whether to report Z45.2 if it is not primary or sequenced as the first listed secondary code. 
 
CMS responded with "[as stated in the CY2020 final rule], include any conditions that exist at the time of home health admission, or that develop during the course of a home health period of care, and that affect patient care planning. That is, diagnoses should be reported that affect or potentially affect patient care (and therefore would be addressed in the home health plan of care), even if such care includes observation and assessment (for actual or potential effects), teaching and training, or direct patient care interventions. If the IV is not the primary reason the patient requires home health care, but where there may be some sort of intervention noted on the home health plan of care, then it would be appropriate to report Z45.2 (but not as the principal or first secondary diagnosis)."