New sepsis aftercare code fills needed gap in long term care rendered to recovering patients

By Brian Murphy
A reminder that we now have access to a new ICD-10-CM code for 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.
UCHealth submitted a request to the CDC for a new code and it made the ICD-10-CM Coordination and Maintenance Committee meeting back in March 2023. And now here we are, with the new code.
Proper coding of Z51.A is therefore a must.
Here are some tips for compliant use:
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
- A has an excludes1 note, indicating it should not be used with follow-up examination after treatment (Z08-Z09)
Related codes
- The Z51 series is Encounters for other aftercare and medical care, so coders are instructed to also code the condition requiring care. Pair Z51.A with other relevant codes, such as those for chronic conditions exacerbated by sepsis or post-sepsis syndrome symptoms, to provide a complete clinical picture.
Providers should ensure that documentation reflects the aftercare nature of the encounter—which obviously distinguishes it from acute care.
Payment and DRG considerations
Z51.A is not a CC or an MCC. But, if it necessitates an admission and is reported as principal, it groups to the MDC 23 and the following MS-DRGs:
- DRG 949: Aftercare with CC/MCC (relative weight 1.0790, geometric mean LOS 4.4 days)
- DRG 950: Aftercare without CC/MCC (0.5861, geometric mean LOS 2.9 days)
Note: Z51.A is exempt from Present on Admission (POA) reporting.
The best article I’ve found on this is by old friend Dr. Erica Remer for Medlearn. Erica adds a great deal of clinical insight on physical manifestations of post-sepsis syndrome, history and evolution of the code, as well as some interesting open-ended questions on how long the code should be used post-sepsis. She also notes that we lack a code for personal history of sepsis.
I’m including a link to her article below.
- Medlearn, A New Code: Z51.A for Sepsis Aftercare
https://icd10monitor.medlearn.com/a-new-code-z51-a-encounter-for-sepsis-aftercare/ - ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual: https://www.cms.gov/icd10m/FY2025-NPRM-Version42-fullcode-cms/fullcode_cms/P0001.html
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