Does anyone have insight on the use of ICD-10 Z45.42 as a principal diagnosis for a vagus nerve stimulator adjustment? The reason for the encounter is the adjustment of the neurostimulator for a patient who has (or had intractable seizures). CMS only covers intractable partial seizure diagnoses but if the device already implanted and is working I would believe you would use Z45.42 in position 1 and the epilepsy diagnosis code in position 2. The problem is if the patient is no longer intractable then you can’t use a covered CMS diagnosis code to manage patients who have controlled their seizures though the use of an already implanted VNS Therapy system. I would be interested in what the AAPC membership thinks about the issue. Many thanks!