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Category Z Codes
Coding from category Z can be a little confusing, but keep in mind that the “Z” codes in ICD-10 were often “V” codes in ICD-9. Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principle) diagnosis or a secondary code, depending on the circumstances of the encounter. Like the old “V” codes, certain Z codes may only be used as the primary diagnosis.
Z codes will indicate a reason for an encounter-they do not replace the CPT code.
There are several categories for Z codes:
Contact/Exposure
These codes are for patients who do not show any signs or symptoms of a disease, but have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic.
Inoculations and Vaccinations
ICD-10 Code Z23 is for encounters for inoculations and vaccinations. It indicates that a patient is being seen to receive a prophylactic inoculation against a disease. The CPT/Procedure code would indicate which vaccine or immunization is being given. Code Z23 may be used as a secondary code if the inoculation is given as part of preventative healthcare, such as a well-baby visit.
In ICD-9, each inoculation/vaccination would have the appropriate “V” code attached to the CPT code. In ICD-10 those many inoculation/vaccination codes that were used in ICD-9 have been combined in to one code, Z23.
Status
Status codes indicate that a patient is either a carrier of a disease of has the sequelae or residual of a past disease or condition. A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code.
History (of)
There are two types of history codes, personal and family. Personal history codes explain a person’s past medical condition that no longer exists, and is not receiving any treatment for, but that has a potential for recurrence and may require additional monitoring.
Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.
Screening
Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provider for those who test positive for the disease.
Keep in mind the difference between screening for a disease and a diagnostic examination. A diagnostic examination is for patients that show signs or symptoms of a disease or disorder (and wouldn’t be coded from this category).
Observation
There are two observation Z codes categories. Z03 is Encounter for medical observation for suspected diseases and conditions ruled out. Z04 is Encounter for examination and observations for other reasons. Observation codes are to be used as the principle diagnosis only.
Aftercare
Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase. The aftercare Z codes should not be used for aftercare of injuries.
Follow Up
The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists.
Donor
Codes under this category are used for living individuals who are donating blood or other body tissue. They are not used to identify cadaveric donations.
Counseling
Codes under this category are used when a patient or family member received assistance in the aftermath of an illness or injury, they are not used in conjunction with a diagnosis code when the counseling component of care is considered integral to standard treatment.
Encounters for Obstetrical and Reproductive Services
Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist, such as in a routine prenatal visit or postpartum care. Encounters for supervision of a normal pregnancy are always coded first and would not be used with any other code from the Obstetrics chapter.
Outcomes of delivery (category Z37) should be included on all maternal delivery records, and is always a secondary code.
Weeks of gestation category codes (Z3A) are for use only on the maternal record to indicate the weeks of gestation of the pregnancy. Code from the Obstetrics chapter first any complications of the pregnancy.
Codes for family planning or procreative management and counseling should be included on an obstetric record either during the pregnancy or the postpartum stage, if applicable.
Newborns and Infants
In addition to the Newborn (perinatal) chapter (Chapter 16), the Z codes listed in here are for either health supervision and care of foundling (Z76.1); Encounter for routine child health examination (Z00.1); and Liveborn infants according to place of birth and type of delivery (Z38).
Routine and Administration Exams
Unlike its predecessor, the general exam code (ICD-9 Code V70.0), breaks into whether or not the exam is with or without suspected or reported diagnosis. These codes should not be used if the examination is for diagnosis of a suspected condition or for treatment purposes. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Pre-existing and chronic conditions as well as history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition.
Miscellaneous Z codes
The miscellaneous Z codes capture a number of other healthcare encounters that do not fall into one of the other categories. Some of these codes identify the reason for the encounter, others are additional codes that provide useful information on circumstances that may affect a patient’s care and treatment.
Kelly Meeks, RHIT, CCS
Sunrise Services, LLC
www.sunrize.com
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