Ask Dr. Z

Sometimes when I am coding LINQ placements (hosp OP billing), the provider lists a CVA or TIA as the only indication, and I presume they are looking for a latent, previously undetected arrhythmia. Then when I look into the patient history, I see that the CVA actually occurred 4-6 weeks prior to the LINQ encounter, and usually the patient has made a full recovery. The cath lab supervisor wants me to code these as an acute CVA from I63. She says that a history code like Z86.73 can never be used as a first listed diagnosis, but I believe that is actually an IP coding rule. Does Z86.73 support medical necessity for an OP LINQ placement?