Can Z Codes Be Listed as a Primary Code?
Encounter codes require knowing sequencing guidelines and Medicare exceptions.
When applied correctly, Z codes amend claims accuracy and specificity, and help to found medical necessity for treatment. That's reason enough to get to know them better.
The Importance of Z Codes
Z codes, found in Chapter 21: Factors Influencing Wellness Status and Contact with Wellness Services (Z00-Z99) of the ICD-10-CM lawmaking volume, may exist used in any healthcare setting. The ICD-10-CM Guidelines for Coding and Reporting instruct usa to code for all circumstantial comorbidities, specially those function of medical decision-making (MDM). It's a skilful idea to review all xvi categories in Chapter 21 of the guidelines:
- Contact/Exposures
- Inoculations and vaccinations
- Condition
- History (of)
- Screening
- Observation
- Aftercare
- Follow Upwardly
- Donor
- Counseling
- Encounters for obstetrical and reproductive services
- Newborns and infants
- Routine and authoritative examinations
- Miscellaneous Z codes
- Nonspecific Z codes
- Z codes that may only be principal/first-listed diagnosis
Z Codes as Principal, Starting time-listed Diagnosis
Some Z codes are reported just as a primary diagnosis. ICD-10-CM guidelines list which Z codes are reportable only as the first listed diagnosis, with exception (Notation: Italics are added for emphasis, bold text is in the original guidelines):
The post-obit Z codes/categories may only exist reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined:
Z00 Encounter for full general examination without complaint, suspected or reported diagnosis
Except: Z00.6
Encounter for exam for normal comparison and command in clinical enquiry plan
Z01 Run across for other special test without complaint, suspected or reported diagnosis
Z02 Encounter for administrative examination
Z03 Encounter for medical observation for suspected diseases and atmospheric condition ruled out
Z04 Run into for exam and observation for other reasons
Z33.2 Encounter for elective termination of pregnancy
Z31.81 Run across for male person gene infertility in female patient
Z31.82 Run across for Rh incompatibility status
Z31.83 Run into for assisted reproductive fertility procedure cycle
Z31.84 Encounter for fertility preservation procedure
Z34 Encounter for supervision of normal pregnancy
Z39 Meet for maternal postpartum care and test
Z38 Liveborn infants according to place of birth and blazon of delivery
Z40 Encounter for safe surgery
Z42 Encounter for plastic and reconstructive surgery post-obit medical procedure or healed injury
Z51.0 See for antineoplastic radiation therapy
Z51.1- Encounter for antineoplastic chemotherapy and immunotherapy
Z52 Donors of organs and tissues
Except: Z52.ix Donor of unspecified organ or tissue
Z76.one Encounter for wellness supervision and care of foundling
Z76.two Meet for health supervision and intendance of other salubrious infant and child
Z99.12 Encounter for respirator [ventilator] dependence during ability failure
Some payers adopt that you report the status of the patient scheduled for surgery as the primary code, with Z01.818 Encounter for other preprocedural examination equally secondary. Bank check payer policies for pre-op billing guidelines.
As another example, Medicare will not pay a laboratory claim if Z00.00 Run across for full general adult medical test without abnormal findings is submitted for rendered services. According to Medicare policy (Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-x-CM) *Oct 2017):
This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the examination, the test may exist billed to the Medicare beneficiary without billing Medicare start considering the service is not covered by statue, in nigh instances because it is performed for screening purposes and is non within an exception. The beneficiary, however, does have a correct to take the merits submitted to Medicare, upon request.
For a list of Z codes non covered by Medicare for laboratory services, go to: www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html.
Z Codes and Natural Disasters
The Centers for Illness Control and Prevention (CDC) also offers coding guidance linked to current events on its website. For example, earlier this year, the CDC documented a reminder on how to assign 10 and Z codes for patients needing treatment for conditions connected to hurricanes:
Injuries incurred as a direct event of the hurricane, assign the appropriate lawmaking(s) for the injuries, followed by the lawmaking X37.0-, Hurricane (with the appropriate seventh graphic symbol), and whatever other applicative external cause of injury codes. Code X37.0- also should be assigned when an injury is incurred because of flooding caused by a levee breaking related to the hurricane. Code X38.-, Alluvion (with the appropriate seventh grapheme), should be assigned when an injury is from flooding resulting directly from the storm.
Z codes (other reasons for healthcare encounters) may be assigned as appropriate to farther explain the reasons for presenting for healthcare services, including transfers between healthcare facilities. The ICD-10-CM Official Guidelines for Coding and Reporting identify which codes maybe assigned as main or first-listed diagnosis just, secondary diagnosis only, or main/commencement-listed or secondary (depending on the circumstances). Possible applicable Z codes include: Z59.0 Homelessness, Z59.1 Inadequate housing.
Resources
Medicare National Coverage Determinations (NCD) Coding Policy Manual and Alter Report (ICD-10-CM): www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201710_ICD10.pdf
ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Backwash Baronial 2017: www.cdc.gov/nchs/data/icd/Hurricane_coding_guidance.pdf
Julie Pisacane, CPMA, CPPM, CEMC, CRHC, CCA, is employed at NYU Langone Health every bit a professional person billing compliance specialist. She reviews medical record documentation of new providers and provides in-service training to physicians and staff resulting from the reviews. Pisacane is a fellow member of the Nassau County, N.Y., local chapter.
Source: https://www.aapc.com/blog/40544-z-codes-whos-on-the-first/
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