General Surgery Coding Alert

Question: Can we use “Z” codes as a primary diagnosis? For instance, if the surgeon sees a patient to remove an existing gastrostomy tube, should we report Z43.1 as the diagnosis for the encounter?

Louisiana Subscriber

Answer: Yes, “Z codes are allowed as primary codes when they are the best description for the main reason a patient is being seen,” says Judy Adams, RN, BSN, HCS-D, AHIMA approved ICD-10-CM Trainer, with Adams Home Care Consulting in Asheville, N.C. You could accurately report the case you describe using Z43.1 (Encounter for attention to gastrostomy).

From a billing point of view, you may use Z codes as either a first-listed (principal diagnosis) or secondary code, depending on the circumstances for the services being provided, affirms Elisa Bovee, Senior Vice President of Operations, Harmony Healthcare International (HHI) in Topsfield, Mass.

In fact, the most common situation for using a Z code as a primary diagnosis is for aftercare situations that report to codes Z40-Z53, including the Z43.1 code that you mention.

Beware: Don’t use Z codes as a primary diagnosis if the patient has an active or complicated medical diagnosis or more specific reason for the encounter.

Also, don’t use Z codes when your surgeon provides aftercare for conditions that require a 7^th character D (subsequent encounter) in ICD-10. For instance, S72.111D (Displaced fracture of greater trochanter of right femur, subsequent encounter for closed fracture with routine healing) makes the use of Z47.89 (Encounter for other orthopedic aftercare) redundant and unnecessary.