# History of... Z codes as primary?



## jorellana42 (Jul 9, 2018)

Hi, everyone!

Are any of the History of Z codes ever permitted to be the primary dx?  I don't believe they are, but my providers insist to code this as the primary Dx.  Please tell me I'm correct.

Thanks!


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## NiteshlalKoyalkar (Jul 9, 2018)

Hi,
yes you are right that history codes cannot be coded as primary dx. 
but as we know every scenario is different and every medical record is one of its own , so sometimes we can code it. 
i will give you an example:
 45 y/o female who presents here for her breast cancer followup who is status post chemotheraphy  and status post mastectomy 9 months comes for  followup with no new complaints..


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## thomas7331 (Jul 10, 2018)

I don't believe that is correct - I am not aware of any ICD-10 coding guideline that say a Z code or history code may not be the primary diagnosis.  

According to the chapter-specific guidelines for Chapter 21 "_Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter_."  The guidelines for the use history codes in this same section of the ICD-10 guidelines state that "_history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring_" which implies that it would be appropriate if that is the code that most accurately reflects the reason for the visit.  There is no restriction mentioned in the guidelines that these codes may not be secondary codes.


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## TThivierge (Jul 12, 2018)

*Z Diagnostic codes as primary diagnostic*

Hi

Yes there are some Z diagnostic codes which can be primary diagnostic field letter A on the CMS1500 claim .However it is depending on setting and patient's documentation of dilemma from the doctor. Check the ICD10 year 2017 AAPC manual pg 1281 of the title page First Listed Z codes. Also realize most Z diagnostic codes come in groupings of , encounters, screenings, history of family and personal  codes are listed on the end of the claim or 2nd place (colon screenings maybe exception first dx). Most physical/preventive visits need a dx. code from the  Z00 diagnostic code block, some births, and aftercare codes. 

History codes to be used should be from the physician's documentation or relevant to the treatment for the day. Using Z dx. codes give the insurance company more information on patient's health.

Well there is my two cents on the topic.


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## jorellana42 (Jul 16, 2018)

Thanks for that information.  I guess I should qualify my question, though.  I know some Z codes are supposed to be primary, but I'm seeing my providers use a Personal History or Family History Z code as the primary, when they really should be coding the reason for the visit as the primary, and let the history code be secondary or tertiary, etc.  Specifically the Personal/Family History codes should not be primary, correct?


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## thomas7331 (Jul 16, 2018)

jorellana42 said:


> Thanks for that information.  I guess I should qualify my question, though.  I know some Z codes are supposed to be primary, but I'm seeing my providers use a Personal History or Family History Z code as the primary, when they really should be coding the reason for the visit as the primary, and let the history code be secondary or tertiary, etc.  Specifically the Personal/Family History codes should not be primary, correct?



You can find your answer in the ICD-10 Guidelines, Section IV - Diagnostic Coding and Reporting Guidelines for Outpatient Services.  Per paragraph G:  _*List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided*. List additional codes that describe any coexisting conditions. In some cases the first-listed diagnosis may be a symptom when a diagnosis has not been established (confirmed) by the physician._  And per paragraph J:  _Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist. However, history codes (categories Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment._


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## jorellana42 (Jul 18, 2018)

thomas7331 said:


> You can find your answer in the ICD-10 Guidelines, Section IV - Diagnostic Coding and Reporting Guidelines for Outpatient Services.  Per paragraph G:  _*List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided*. List additional codes that describe any coexisting conditions. In some cases the first-listed diagnosis may be a symptom when a diagnosis has not been established (confirmed) by the physician._  And per paragraph J:  _Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist. However, history codes (categories Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment._



Thanks so much, Thomas!  I should have looked in the ICD-10 Guidelines.  I'll bring this up with my Medical Director.


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