Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Guidelines
Comprehensive guide for understanding Z codes in healthcare settings
Introduction
Understanding Z Codes in Healthcare
Note: The chapter specific guidelines provide additional information about the use of Z codes for specified encounters.
Use of Z Codes in Any Healthcare Setting
Z codes are for use in any healthcare setting. 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. Certain Z codes may only be used as first-listed or principal diagnosis.
Z Codes Indicate a Reason for an Encounter
Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed. Z codes provide additional information about a patient encounter.
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Categories of Z Codes: Contact/Exposure and Vaccinations
1. Contact/Exposure
Category Z20 indicates contact with, and suspected exposure to, communicable diseases. These codes are for patients who are suspected to have been exposed to a disease by close personal contact with an infected individual or are in an area where a disease is epidemic.
Category Z77, Other contact with and (suspected) exposures hazardous to health, indicates contact with and suspected exposures hazardous to health.
Contact/exposure codes may be used as a first-listed code to explain an encounter for testing, or, more commonly, as a secondary code to identify a potential risk.
2. Inoculations and Vaccinations
Code Z23 is for encounters for inoculations and vaccinations. It indicates that a patient is being seen to receive a prophylactic inoculation against a disease.
Procedure codes are required to identify the actual administration of the injection and the type(s) of immunizations given.
Code Z23 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as a well-baby visit.
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Status Codes: Understanding Patient Status
Status codes indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition. This includes such things as the presence of prosthetic or mechanical devices resulting from past treatment. A status code is informative, because the status may affect the course of treatment and its outcome.
Z14 Genetic carrier
Genetic carrier status indicates that a person carries a gene, associated with a particular disease, which may be passed to offspring who may develop that disease. The person does not have the disease and is not at risk of developing the disease.
Z15 Genetic susceptibility to disease
Genetic susceptibility indicates that a person has a gene that increases the risk of that person developing the disease. Codes from category Z15 should not be used as principal or first-listed codes.
Z16 Resistance to antimicrobial drugs
This code indicates that a patient has a condition that is resistant to antimicrobial drug treatment. Sequence the infection code first.
Z21 Asymptomatic HIV infection status
This code indicates that a patient has tested positive for HIV but has manifested no signs or symptoms of the disease.
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Additional Status Code Categories
Z22 Carrier of infectious disease
Carrier status indicates that a person harbors the specific organisms of a disease without manifest symptoms and is capable of transmitting the infection.
Z28.3 Under immunization status
See Section I.B.14. for under immunization documentation by clinicians other than the patient's provider.
Z33.1 Pregnant state, incidental
This code is a secondary code only for use when the pregnancy is in no way complicating the reason for visit. Otherwise, a code from the obstetric chapter is required.
Z66 Do not resuscitate
This code may be used when it is documented by the provider that a patient is on do not resuscitate status at any time during the stay.
Z68 Body mass index (BMI)
BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity). Do not assign BMI codes during pregnancy.
Z76.82 Awaiting organ transplant status
Used to indicate a patient is awaiting organ transplantation.
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Long-Term Drug Therapy and Additional Status Codes
Z79 Long-term (current) drug therapy
Codes from this category indicate a patient's continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs.
This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug use, abuse, or dependence instead.
Assign a code from Z79 if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer).
Do not assign a code from category Z79 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis).
Other Important Status Codes
- Z88 Allergy status to drugs, medicaments and biological substances (Except: Z88.9, Allergy status to unspecified drugs, medicaments and biological substances status)
- Z89 Acquired absence of limb
- Z90 Acquired absence of organs, not elsewhere classified
- Z91.0- Allergy status, other than to drugs and biological substances
- Z92.82 Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to a current facility
- Z93 Artificial opening status
- Z94 Transplanted organ and tissue status
- Z95 Presence of cardiac and vascular implants and grafts
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History Codes: Personal and Family History
There are two types of history Z codes, personal and family. Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.
Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.
Family History Categories
- Z80 Family history of primary malignant neoplasm
- Z81 Family history of mental and behavioral disorders
- Z82 Family history of certain disabilities and chronic diseases
- Z83 Family history of other specific disorders
- Z84 Family history of other conditions
Personal History Categories
- Z85 Personal history of malignant neoplasm
- Z86 Personal history of certain other diseases
- Z87 Personal history of other diseases and conditions
- Z91.4- Personal history of psychological trauma
- Z91.5- Personal history of self-harm
- Z92 Personal history of medical treatment
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Screening, Observation, and Aftercare Codes
5. Screening
Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram).
The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening.
Screening Z codes/categories: Z11 (infectious diseases), Z12 (malignant neoplasms), Z13 (other diseases), Z36 (antenatal screening)
6. Observation
There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out.
The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected condition are present.
Observation Z code categories: Z03 (suspected diseases ruled out), Z04 (examination for other reasons), Z05 (newborn observation)
7. Aftercare
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.
The aftercare Z code should not be used if treatment is directed at a current, acute disease.
Aftercare categories: Z42-Z51 (various aftercare encounters)
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Follow-up, Donor, and Counseling Codes
8. Follow-up
The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists.
They should not be confused with aftercare codes, or injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition or its sequelae.
Follow-up Z codes:
- Z08 Follow-up after malignant neoplasm treatment
- Z09 Follow-up after other conditions treatment
- Z39 Maternal postpartum care
9. Donor
Codes in category Z52, Donors of organs and tissues, are used for living individuals who are donating blood or other body tissue.
These codes are for individuals donating for others, as well as for self-donations. They are not used to identify cadaveric donations.
10. Counseling
Counseling Z codes are used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems.
Counseling categories include:
- Z30.0- Contraception counseling
- Z31.5 Procreative genetic counseling
- Z69 Mental health services
- Z70 Sexual counseling
- Z71 Other counseling
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Obstetrical, Newborn, and Administrative Examination Codes
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11. Encounters for Obstetrical and Reproductive Services
Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist (a routine prenatal visit or postpartum care).
Codes in category Z34, Encounter for supervision of normal pregnancy, are always first listed and are not to be used with any other code from the OB chapter.
Key categories: Z30 (contraceptive management), Z31 (procreative management), Z33 (pregnant state), Z34 (normal pregnancy supervision), Z37 (outcome of delivery), Z39 (postpartum care)
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12. Newborns and Infants
See Section I.C.16. Newborn (Perinatal) Guidelines, for further instruction on the use of these codes.
Newborn Z codes/categories: Z76.1 (health supervision of foundling), Z00.1- (routine child health examination), Z38 (liveborn infants according to place of birth and type of delivery)
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13. Routine and Administrative Examinations
The Z codes allow for the description of encounters for routine examinations, such as, a general check-up, or, examinations for administrative purposes, such as, a pre-employment physical.
The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used.
Key categories: Z00 (general examination), Z01 (special examination), Z02 (administrative examination), Z32.0- (pregnancy test)
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Miscellaneous, Nonspecific, and Social Determinants of Health
14. Miscellaneous Z Codes
The miscellaneous Z codes capture a number of other health care encounters that do not fall into one of the other categories. Some of these codes identify the reason for the encounter; others are for use as additional codes that provide useful information on circumstances that may affect a patient's care and treatment.
15. Nonspecific Z Codes
Certain Z codes are so non-specific, or potentially redundant with other codes in the classification, that there can be little justification for their use in the inpatient setting. Their use in the outpatient setting should be limited to those instances when there is no further documentation to permit more precise coding.
Examples: Z02.9 (unspecified administrative exam), Z04.9 (unspecified examination), Z13.9 (unspecified screening), Z88.9 (unspecified allergy status)
16. Z Codes That May Only be Principal/First-Listed Diagnosis
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.
Examples: Z00 (general examination), Z01 (special examination), Z02 (administrative examination), Z34 (normal pregnancy supervision), Z38 (liveborn infants), Z51.0 (radiation therapy), Z52 (organ donors)
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Social Determinants of Health and Scenario Examples
17. Social Determinants of Health
Social determinants of health (SDOH) codes describing social problems, conditions, or risk factors that influence a patient's health should be assigned when this information is documented in the patient's medical record. Assign as many SDOH codes as are necessary to describe all of the social problems, conditions, or risk factors documented during the current episode of care.
Documentation by a clinician (or patient-reported information that is signed off by a clinician) that the patient expressed concerns with access and availability of food would support assignment of code Z59.41, Food insecurity. Similarly, medical record documentation indicating the patient is homeless would support assignment of a code from subcategory Z59.0-, Homelessness.
Social determinants of health codes are located primarily in these Z code categories: Z55 (education and literacy), Z56 (employment), Z57 (occupational exposure), Z58 (physical environment), Z59 (housing and economic circumstances), Z60 (social environment), Z62 (upbringing), Z63 (primary support group), Z64 (psychosocial circumstances), Z65 (other psychosocial circumstances)
Five Scenario Examples for ICD-10-CM Chapter 21 Guidelines
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Scenario 1: Routine Health Screening
Patient Presentation: A 45-year-old female presents for her annual wellness examination with no complaints. During the visit, a screening mammogram is ordered.
Coding: Z00.00 (Encounter for general adult medical examination without abnormal findings) as principal diagnosis, Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast) as secondary diagnosis.
Guideline Applied: Section 13 - Routine and Administrative Examinations. The screening code Z12.31 is used as a secondary code because the screening is part of the routine examination.
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Scenario 2: Contact with Infectious Disease
Patient Presentation: A 30-year-old male presents to the clinic after being exposed to a co-worker who tested positive for tuberculosis. The patient has no symptoms but requests testing.
Coding: Z20.1 (Contact with and exposure to tuberculosis) as principal diagnosis.
Guideline Applied: Section 1 - Contact/Exposure. The contact/exposure code is used as a first-listed code to explain the encounter for testing.
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Scenario 3: Long-term Medication Therapy
Patient Presentation: A 65-year-old patient with a history of deep vein thrombosis presents for follow-up. The patient continues on long-term anticoagulant therapy with warfarin for prophylaxis.
Coding: Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) as principal diagnosis, Z79.01 (Long term (current) use of anticoagulants) as secondary diagnosis, Z86.718 (Personal history of other venous thrombosis and embolism) as additional secondary diagnosis.
Guideline Applied: Section 3 - Status codes (Z79) and Section 4 - History codes. The Z79.01 status code indicates ongoing anticoagulant therapy, while Z86.718 provides the historical context.
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Scenario 4: Observation for Suspected Condition Ruled Out
Patient Presentation: A 28-year-old pregnant woman at 32 weeks gestation presents to the emergency department with decreased fetal movement. After monitoring and ultrasound, fetal distress is ruled out and the patient is discharged.
Coding: Z03.71 (Encounter for suspected problem with amniotic cavity and membrane ruled out) as principal diagnosis, Z3A.32 (32 weeks gestation of pregnancy) as secondary diagnosis.
Guideline Applied: Section 6 - Observation. The observation code Z03.71 is used because the suspected fetal condition was ruled out during the encounter.
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Scenario 5: Social Determinants of Health - Food Insecurity
Patient Presentation: A 55-year-old patient with type 2 diabetes presents for routine follow-up. During the visit, the patient reports difficulty affording healthy food and expresses concerns about food insecurity. The provider documents this concern and refers the patient to community resources.
Coding: E11.9 (Type 2 diabetes mellitus without complications) as principal diagnosis, Z59.41 (Food insecurity) as secondary diagnosis.
Guideline Applied: Section 17 - Social Determinants of Health. The SDOH code Z59.41 is assigned based on the provider's documentation of the patient's expressed concerns about food access and availability.
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