Oncology & Hematology Coding Alert

Yes, you can use these as primary diagnoses in certain circumstances.

Whether using ICD-10 is still giving you a headache or you’re already an expert, you may still be confused about certain aspects of the diagnosis coding manual. One such area that has many oncology practices stymied is the use of “Z” codes, which describe “Factors influencing health status and contact with health services.”

If you think the Z codes don’t apply to your practice, you’re probably incorrect — read on to determine how these codes can help you collect.

If a Z Code is the Best Option, Use it

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.”

One common instance when practices select a Z code as a primary diagnosis is for screening exams. These include several codes that describe screenings for neoplasms (for instance, Z12.9,  Encounter for screening for malignant neoplasm, site unspecified).

Be aware: A “screening” means that the surgeon performs an exam to determine the presence of a condition in the absence of any relevant signs or symptoms and should be reserved for occasions when the doctor is screening a patient preventively. Typically, an oncologist will only see a patient after that patient has already been diagnosed with or suspect of having cancer, which means you would use a more specific code than a screening code for these visits.

ICD-10 Offers Myriad Z Code Opportunities

You might also use Z codes as primary diagnosis when the oncologist provides care for a patient with current or past injuries and/or treatment.

Example: A patient presents for aftercare to address the functionality of an implanted infusion pump. You’ll report Z45.1 (Encounter for adjustment and management of infusion pump) to describe the reason for the visit.

Example 2: A patient presents for an antineoplastic chemotherapy infusion. In this case, you’ll report Z51.11 (Encounter for antineoplastic chemotherapy).

Example 3: Coders and physicians often make the mistake of overlooking Z codes for patients whose disease processes are no longer active, but this is another area where these codes are helpful.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 oncologist 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.