What Coders Need to Know: Anticoagulant versus Antiplatelet – Coding Considerations

Continuing our look at areas where we see confusion we will examine the assignment of the long term use codes for anticoagulants versus antithrombotics/antiplatelets. 

GoodRx.com, in an article titled, “Antiplatelet vs. Anticoagulant Blood Thinners – 4 Things to Know,” details the basics coders need to keep in mind when assigning these codes.  First, these drugs have the same goal but work in different ways.  Antiplatelet drugs prevent the platelets from sticking together so they can’t form clots.  Plavix, Brilinta and Aggrenox are some antiplatelet medications. 

Low dose aspirin is also considered to be an antiplatelet medication.  Coders note long term use of aspirin has its own unique code assignment.  These medications are often prescribed to prevent strokes and heart attacks. 

Anticoagulant drugs also have the goal of preventing clots by affecting clotting factors.   GoodRx details three main types of anticoagulants.  DOACs or direct-acting oral anticoagulants, Vitamin K antagonists and Heparins.  DOACs prevent clots by blocking factor Xa or thrombin.  Eliquis, Xarelto and Pradaxa are examples of DOACs.  Vitamin K antagonists do exactly what the name infers, they block the formation of vitamin K, which is necessary to make clotting factors.  Coumadin is a vitamin K antagonist.  Finally, heparins block the formation of both thrombin and factor Xa by activating antithrombin.  Heparin, Lovenox and Fragmin are examples.  Anticoagulants are often used in the treatment of deep venous thromboses, pulmonary embolisms and atrial fibrillation. 

Looking at our codes, they are found at Z79 Long term (current) drug therapy.  Remember here we have that non- essential modifier term for current.  This category includes long term (current) drug use for prophylactic purposes.  Z79.0 Long term (current) use of anticoagulants and antithrombotics also has an Excludes 2 note.  This note references long term (current) use of aspirin (Z79.82).  This tells the coder that if the patient is taking an anticoagulant or antithrombotic in addition to aspirin, both codes are needed. 

Z79.01 would be assigned for those anticoagulants, your heparin, Coumadin or Eliquis for example.  Z79.02 would be assigned for antithrombotic/antiplatelet use, that Plavix for example. 

It is the coder’s responsibility to research and verify prior to code assignment.   Many encoders have drug references that make verification easy.  Some code book publishers have drug references as an appendix as well. 

This would be another opportunity for coder education as a refresher on these commonly prescribed medications. 

It would be a worthwhile exercise to do a spot audit to see how your coding team is assigning for these medications.  You could also make it a fun exercise by developing a quiz or a match the drug name to drug type game.  This would not only allow you to gauge your coders understanding of these medications but could also be a great team building exercise.