Wiki Personal History of Cancer-- Invalid principal diagnosis?

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toria11

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The ICD-10 guidelines were updated and we are now seeing denials when using Z85.51 as the principal diagnosis on an office visit. What would you suggest we use if, for example, a patient is coming in for a follow up with a personal history of bladder cancer and no other issues? Or if we perform a surveillance cysto for the same reason? Z85.46 is another one we use often and sometimes that is the only problem being addressed. Thanks!!
 
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toria11 said:
The ICD-10 guidelines were updated and we are now seeing denials when using Z85.51 as the principal diagnosis on an office visit. What would you suggest we use if, for example, a patient is coming in for a follow up with a personal history of bladder cancer and no other issues? Or if we perform a surveillance cysto for the same reason? Z85.46 is another one we use often and sometimes that is the only problem being addressed. Thanks!!
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This isn't new - the guidelines have always stated not to use a history of neoplasm code as a first-listed diagnosis.

Payers are getting more savvy about rejecting claims when the guidelines aren't being followed, which is probably why you're seeing denials when you didn't before.

Refer to the guidelines I.C.21.c.4 under History (of):

The reason for the encounter (for example, screening or counseling)should be sequenced first and the appropriate personal and/or family history code(s) should be assigned as additional diagnos(es).


Typically, for a history of neoplasm, you'd use Z08—Encounter for follow-up examination after completed treatment for malignant neoplasm (Medical surveillance following completed treatment). Depending on the purpose of the visit, other appropriate encounter codes may also be appropriate.
 
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Thank you both for the guidance! I found what I needed. I think I got caught up and misunderstood this list, but it's just saying that these Z codes can ONLY be listed first when used, not saying these are the ONLY Z codes that can be listed first. Z08 was my first thought-- that we should be coding that first for these types of visits but it wasn't on the list so I was thinking it Z08 couldn't be listed first either. But the personal history codes are secondary codes only so that's why we're getting denials. "Personal history codes may be used in conjunction with follow-up codes" like Z08.

The following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined:
  • Z00 Encounter for general examination without complaint, suspected or reported diagnosis Except: Z00.6
  • Z01 Encounter for other special examination without complaint, suspected or reported diagnosis Z02 Encounter for administrative examination
  • Z04 Encounter for examination and observation for other reasons
  • Z33.2 Encounter for elective termination of pregnancy
  • Z31.81 Encounter for male factor infertility in female patient
  • Z31.83 Encounter for assisted reproductive fertility procedure cycle
  • Z31.84 Encounter for fertility preservation procedure
  • Z34 Encounter for supervision of normal pregnancy
  • Z39 Encounter for maternal postpartum care and examination
  • Z38 Liveborn infants according to place of birth and type of delivery
  • Z40 Encounter for prophylactic surgery
  • Z42 Encounter for plastic and reconstructive surgery following medical procedure or healed injury
  • Z51.0 Encounter for antineoplastic radiation therapy
  • Z51.1- Encounter for antineoplastic chemotherapy and immunotherapy
  • Z52 Donors of organs and tissues Except: Z52.9, Donor of unspecified organ or tissue
  • Z76.1 Encounter for health supervision and care of foundling
  • Z76.2 Encounter for health supervision and care of other healthy infant and child
  • Z99.12 Encounter for respirator [ventilator] dependence during power failure
 
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toria11 said:
Can Z08 be used with procedures too?
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I suppose I would first question why you are doing a procedure if the treatment of the malignancy is completed. I've only used for surveillance visits. The description states "follow-up examination".
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Medical surveillance following completed treatment
Use additional code to identify any acquired absence of organs (Z90.-)
Use additional code to identify the personal history of malignant neoplasm (Z85.-)
Excludes1: aftercare following medical care (Z43-Z49, Z51)

​

 
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csperoni said:
I suppose I would first question why you are doing a procedure if the treatment of the malignancy is completed. I've only used for surveillance visits. The description states "follow-up examination".
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Medical surveillance following completed treatment
Use additional code to identify any acquired absence of organs (Z90.-)
Use additional code to identify the personal history of malignant neoplasm (Z85.-)
Excludes1: aftercare following medical care (Z43-Z49, Z51)

​

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We often do surveillance cystoscopies for patients with a history of bladder cancer.
 
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toria11 said:
We often do surveillance cystoscopies for patients with a history of bladder cancer.
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One of the alternate descriptions of Z08 is "Medical surveillance following completed treatment," so I think Z08 would be acceptable to use for a surveillance procedure. (This assumes the documentation supports that it was surveillance, of course.)
 
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toria11 said:
We often do surveillance cystoscopies for patients with a history of bladder cancer.
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I agree with @sls314 that Z08 would be appropriate for that situation (assuming no sign/symptoms issues). When I was thinking of "procedure" I was thinking of something more involved. To me, a cystoscopy (or colposcopy) is really more of an exam/look with a specialized device. But yes, they are procedures by coding definition.
 
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csperoni said:
I agree with @sls314 that Z08 would be appropriate for that situation (assuming no sign/symptoms issues). When I was thinking of "procedure" I was thinking of something more involved. To me, a cystoscopy (or colposcopy) is really more of an exam/look with a specialized device. But yes, they are procedures by coding definition.
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Awesome, thank you!!
 
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Hello Toria
Some of the Z codes listed above should NOT be first listed or principle Dx. code on claims per the ICD 10 manual These are not first listed dx codes such as: Z34, Z76, Z99, Z40,andZ42.You can use these as secondary or last dx on claims per documentation. As stated in ICD10 manual need additional dx codes to describe the original illness or definitive dx related to condition seeking treatment.
I hope helped you with this data
Lady T
 
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