2025 ICD-10-CM code Z89.5
Acquired absence of leg below knee.
The medical necessity for using Z89.5 is to accurately document a patient's health status and history, particularly for conditions that influence ongoing healthcare needs and management. It aids in tracking the long-term effects of limb loss and justifying related services like prosthetics or rehabilitation.
Clinicians use this code to document a patient's status post amputation or limb loss. It's crucial for tracking the patient's condition and planning appropriate care, such as prosthetic fitting and rehabilitation.
In simple words: This code indicates that the patient is missing a leg below the knee due to an acquired reason, such as amputation or injury.
Acquired absence of leg below knee. This code includes amputation status post, procedural loss of limb, and post-traumatic loss of limb.
Example 1: A patient had their leg amputated below the knee due to complications from diabetes. Z89.5 is used to document this condition., A patient experienced a traumatic injury in a car accident, resulting in the loss of their leg below the knee. Z89.5 is used to record this acquired absence., A patient underwent a surgical procedure that necessitated the removal of their leg below the knee. Z89.5 is used to indicate this status post-procedure.
Documentation should clearly specify the cause of the amputation (e.g., trauma, diabetes, peripheral vascular disease), the level of the amputation (below the knee), and any relevant history, such as previous amputations or limb loss.
** This code is used to indicate a past event that influences the patient's current health status. It is not used to describe the reason for the current visit. Always code any current medical conditions or injuries in addition to Z89.5.
- Specialties:Physical Medicine and Rehabilitation, Orthopedic Surgery, General Surgery, Vascular Surgery, Primary Care, Prosthetics and Orthotics
- Place of Service:Inpatient Hospital, Outpatient Hospital, Physician's Office, Rehabilitation Facility, Skilled Nursing Facility