Neurology & Pain Management Coding Alert

Question: OK, settle a debate we’ve been having in the coding office. Some coders say Z codes can never be used as primary diagnosis codes; others say you can use Z codes as the primary diagnosis in certain situations. Who’s right?

Wisconsin Subscriber

Answer: Contrary to what some coders believe, you may — and on occasion should — report Z codes as primary diagnoses. “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 ICD-10 manual says. “Certain Z codes may only be used as a first-listed or principal diagnosis.”

Perhaps the most common instance when you should select a Z code as a primary diagnosis is for screening exams, such as Z13.850 (Encounter for screening for traumatic brain injury).

Be aware: A “screening” means that the provider performs an exam to determine the presence of a condition in the absence of any relevant signs or symptoms.

So let’s say a patient presents with symptoms such as dizziness (R42), headaches (R51), and nausea (R11.0), and the physician wants to examine the patient for a neoplasm of the brain. In this case, you should use the signs and symptoms to justify the exam rather than a screening code such as Z12.81. You’ll reserve the screening code for preventive situations.

Coders and physicians often make the mistake of overlooking Z codes for patients whose disease processes are no longer active, but this is another area where these codes are helpful. For instance, a female patient who has successfully undergone surgery for removal of a brain neoplasm visits the surgeon for evaluation of wound and neurological deficits.

In this case, rather than report an acute diagnosis of brain neoplasm (for instance, C71.1,  Malignant neoplasm of frontal lobe) — which is inaccurate — you should select Z48.3 (Aftercare following surgery for neoplasm) to reflect that the checkup is for a condition that is no longer acute. “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, or for the long-term consequences of the disease,” according to ICD-10 guidelines.