MDS Alert

Know what makes Z codes different from other ICD-10 codes.

Residents are admitted to nursing facilities for all sorts of reasons, and diagnosis codes are crucial for reimbursement under the Patient-Driven Payment Model (PDPM). However, a resident’s actual diagnosis may not tell the most accurate story of why they’ve been admitted; Z codes may be a better fit.

There are 16 categories of Z codes, according to the ICD-10-CM code book. As you read through the list, you’ll notice that only some are pertinent to nursing facilities, but knowing exactly how Z codes work is important to coding diagnoses correctly.

Here are the general situations encompassed by Z codes:

1.  Contact/Exposure: When a person has been exposed to a communicable disease or has had contact with a factor hazardous to health, such as Z20.811 (Contact with and [suspected] exposure to meningococcus).

2.  inoculations and vaccinations: When a person presents for the sole purpose of getting an inoculation, you’d report Z23 (Encounter for immunization).

3.  Status: This series indicates that a resident either carries a disease or has the sequelae or residual of past diseases or conditions, such as Z16.11 (Resistance to penicillins).

4. History (of): This demonstrates either a personal history or a family history of a condition or disease, such as Z82.0 (Family history of epilepsy and other diseases of the nervous system).

5.  screening: These codes describe the testing to screen for a particular disease or diagnosis, such as Z13.858 (Encounter for screening for other nervous system disorders).

6.  Observation: These codes “are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out,” the ICD-10-CM code book says. For instance, Z03.89 (Encounter for observation for other suspected diseases and conditions ruled out).

7.  Aftercare: These codes describe continued care following the completion of a disease’s healing or recovery phase, such as Z45.41 (Encounter for adjustment and management of cerebrospinal fluid drainage device).

8. Follow-up: You’ll use follow-up Z codes to explain continuing surveillance after the treatment phase of a disease, condition, or injury is completed. For instance, this series includes Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm).

9. Donor: These codes are used for living donors of blood or body tissues, such as Z52.89 (Donor of other specified organs or tissues).

10.  Counseling: Codes in this category describe counseling for patients or their family following an illness or injury, such as Z71.1 (Person with feared health complaint in whom no diagnosis is made).

11.  Encounters for obstetrical and Reproductive services: You’d append these codes for pregnant patients who don’t have problems or complications, such as Z33.1 (Pregnant state, incidental).

12.  Newborns and Infants: You’ll report these codes to describe the care of an infant, with options such as Z76.1 (Encounter for health supervision and care of foundling).

13. Routine and Administrative Examinations: These codes allow you to describe encounters for situations such as checkups and pre-employment physicals, for example, Z01.818 (Encounter for other preprocedural examination).

14. Miscellaneous Z Codes: Here you’ll find codes for healthcare encounters that don’t fit into the above categories, such as Z57.4 (Occupational exposure to toxic agents in agriculture).

15. Nonspecific Z Codes: These codes are typically limited to situations where the documentation limits more precise coding, such as Z04.9 (Encounter for examination and observation for unspecified reason).

16.  Z Codes That May only Be Principal/First-Listed Diagnosis:  You must list the diagnoses in this category as the principal diagnosis unless the patient has multiple encounters on the same date and they are combined. The codes in this category include Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out).

The Z code categories break down further into these components:

• Z00-Z13: Persons encountering health services for examinations
• Z14-Z15: Genetic carrier and genetic susceptibility to disease
• Z16: Resistance to antimicrobial drugs
• Z17: Estrogen receptor status
• Z18: Retained foreign body fragments
• Z19-Z20: Persons with potential health hazards related to communicable diseases
• Z40-Z53: Encounters for other specific health care
• Z55-Z65: Persons with potential health hazards related to socioeconomic and psychosocial circumstances
• Z66: Do not resuscitate status
• Z67: Blood type
• Z68: Body mass index [BMI]
• Z69-Z76: persons encountering health services in other circumstances
• Z77-Z99: Persons with potential health hazards relating to family and personal history and certain conditions influencing health status