Ask Dr. Z

I see a lot of patients come in for routine dialysis catheter exchange with ESRD, and I code this as Z49.01, N18.6. My reviewer recommended to me that I should add Z99.2 as well. My view is that Z49.01 includes the fact that the patient is on dialysis, and there is an "excludes 1" between these two codes stating they should not be reported together. Her view, which I can see as well, is that there is a "code also" notation under N18.6 stating to add the Z99.2. She also pointed out that Z49.01 doesn’t give the full picture because it doesn’t state if the patient is on temporary or chronic dialysis. For example, if patient had a temporary dialysis catheter and was coming in to have it replaced with a permanent catheter, Z99.2 would help explain that the patient needed chronic dialysis. What are your thoughts on this?