Otolaryngology Coding Alert

These codes serve a more important purpose than you may understand.

When it comes to diagnosis coding, many coders who were well-versed in ICD-9-CM had some of the “V” codes committed to memory. Following the transition to ICD-10-CM, some coders didn’t get to know the ‘Z’ codes just as well.

If you’re in that category and haven’t yet embraced the value of Z codes, now is the time. These codes not only provide supplemental information on your claims, they could actually be the key that tells payers why they should reimburse you for your services. The Z codes are, in fact, important elements to correct coding practices.

The Z code category is formally referred to as “Factors influencing health status and contact with health services” in the ICD-10-CM Guidelines and code manual. The following tips can help ensure that you’re using Z codes properly at your ENT practice.

Some Z Codes Can Be Listed As Primary Diagnoses

Many coders are hesitant to use the Z codes as primary codes on their claims, but this is perfectly acceptable in many cases, says Dee Mandley, RHIT, CCS, CCS-P, president of D. Mandley & Associates, LLC in Stow, Ohio. “There are a few Z codes that can only be used as first-listed diagnoses. These are listed in the ICD-10-CM Official Guidelines for Coding and Reporting.”

These include Z01.10 (Encounter for examination of ears and hearing without abnormal findings), Z01.110 (Encounter for hearing examination following failed hearing screening), and Z01.118 (Encounter for examination of ears and hearing with other abnormal findings), among others. One that should be often used surgically after cancers are removed is Z42.8 (Encounter for other plastic and reconstructive surgery following medical procedure or healed injury).

Paint the Picture With Z Codes

In other cases, when the Z codes aren’t your primary diagnoses, you’ll simply list them after your primary diagnosis codes to give the insurer a complete profile of what your patient is dealing with, Mandley says. “A coder will always want to code all codes necessary to ‘paint the picture’ for why the patient is being seen.”

The reason for this is because the Z codes give the insurer additional information that may offer reasons why the doctor needed to report a high er-level evaluation and management (E/M) service, perform procedures, or order diagnostic workups. Remember: it’s appropriate to code all diagnoses that coexist at the time of the visit that affect patient treatment or management — this includes status conditions (Z codes). As always, make sure documentation supports your coding.

Providers should specify which conditions and/or situations that they want to report in terms of additional Z codes, says Mandley. “If there are conditions that are being used for reports and/or statistical analysis, then there should be a specific ‘in-house’ coding guideline written so it’s clear what codes are expected to be reported,” she advises.

In situations when a payer requires you to report a Z code, such as Z88.0 (Allergy status to penicillin), to justify a more expensive antibiotic, then the payer should provide this in writing and your office should keep this information in its internal coding guidelines, Mandley says. However, most experts caution against coding every little situation (such as history of right hip replacement when the patient is being seen for hearing loss), as this takes extra time and would affect productivity.

Document Everything

As with all other codes, never report a Z code unless your documentation reflects the condition that the Z codes describe. For example, suppose your insurer allows Z86.005 (Personal history of in-situ neoplasm of middle ear and respiratory system) as a payable code for a computerized tomography (CT) scan of the head. If you’re using that code, you must ensure that the patient’s records include a documented history of neoplasm somewhere in the respiratory system or middle ear.

In addition, if a payer allows a family history code as a payable diagnosis, it should be satisfactory to have the family history documented in the patient’s medical record. Keep in mind, however, that what one payer allows as a payable diagnosis might not be the same as what a separate insurer might cover.

If the patient’s insurer does cover services performed due to family histories of certain conditions as payable diagnoses, you should ask the payer for the coverage decision so you can prove where it’s allowable. “It would be helpful to get a copy of this requirement from the payer for the provider’s coding compliance manual,” Mandley says.

Aftercare Provides More Z Code Opportunities

You might also use Z codes as primary diagnoses when the surgeon provides follow-up care for a patient with past injuries and/or treatment.

Example: A patient presents for aftercare following a tracheostomy. You’ll report Z43.0 (Encounter for attention to tracheostomy) to describe the reason for the visit.