ICD-10-CM Coding Guidelines - Factors Influencing Health Status and Contact with Health Services (Chapter 21)
Chapter 21 in ICD-10-CM is titled "Factors Influencing Health Status and Contact with Health Services." This chapter covers code categories Z00-Z99. Conditions covered in this chapter are those related to routine checkups, risk factors, the presence of prosthetic devices, screenings for diseases, and exposure to an infectious disease.
Z00-Z13 Persons Encountering Health Services for Examinations – Codes in this subsection correspond with those in categories V70-V82 in ICD-9-CM. The codes in this category are status codes, which report that the patient has a residual condition from a previous disease or is the carrier of a specific disease.
Z20-Z28 Persons with Potential Health Hazards Related to Communicable Diseases - Codes in this subsection correspond with those in categories V08-V09 in ICD-9-CM.
Z30-Z39 Persons Encountering Health Services in Circumstances Related to Reproduction - Codes in this subsection correspond with those in categories V20-V29 in ICD-9-CM. Pregnancy Z codes are only assigned for routine prental or postpartum care, and in the absence of any other obstetric codes.
Z40-Z53 Encounters for Other Specific Healthcare - Codes in this subsection correspond with those in categories V50-V59 in ICD-9-CM. These codes are first-listed to report the reasons for the encounter, but when listed as secondary codes, they reflect the provision of aftercare.
Z55-Z65 Persons with Potential Health Hazards Related to Socioeconomic and Psychosocial Circumstances - Codes in this subsection are scattered throughout ICD-9-CM. These codes report problems related to literacy, education, employment, occupational exposure to risk factors, housing circumstances, social environment, primary support group, and other psychosocial issues.
Z69-Z76 Persons Encountering Health Services in Other Circumstances - Codes in this subsection correspond with those in categories V60-V69 in ICD-9-CM. Situation reported by these codes are those for mental health services for the victim of abuse, counseling related to sexual behavior, attitude, and orientation, provider dependency, and other circumstances.Interested in learning more? Why not take an online class in ICD-10?
Z79-Z99 Persons with Potential Health Hazards Related to Family and Personal History and Certain Conditions Influencing Health Status - Codes in this subsection correspond with those in categories V10-V19 in ICD-9-CM. Family history codes are reported with categories Z80-Z84, and personal history codes are reported with categories Z85-Z92. Z79 codes are assigned for patients using prescribed medicines.
If a Z code is assigned to indicate that the patient had a surgery or procedure, then the coder must also assign a procedure code.
Various Terms useful in search for codes in this category include: "history of," "aftercare," "status," test," palliative care," "management," "long-term," "follow-up," "counseling," and "encounter for."
Codes in categories Z00-Z13 are only for encounters for routine examinations, and they are not to be used for examinations for the diagnosis of a condition or for treatment purposes.
Observation Z codes are only used in limited situations, such as when a patient is being observed for a suspected disease or condition that is ruled out, or when there are no symptoms or injury related to the suspected condition.
Codes in category Z23 are only used to report a patient who receives a prophylactic examination.
The coder should assign Z33.1 only as a secondary code, used to reflect that a patient is pregnant, but that the pregnancy is not the reason for the encounter.
Codes from category Z34, Encounter for supervision of normal pregnancy, are always listed first, and never used along with other obstetric codes.
Codes in the category for after care (Z51) are assigned during the acute treatment phase when a patient is seen in order to receive radiation therapy for a neoplasm, and also when a patient is seen to receive immunotherapy or chemotherapy.
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