Learn when to use Z codes in ICD 10
Status Z codes for Vascular Catheter placement
Before giving Chemotherapy to cancer patient, doctors usually place a port or catheter in chest to give required drugs for neoplasm. This catheter can be placed as non-tunneled or tunneled in chest. The CPT codes used for placing the vascular catheter range from 36555-36571. This code range will include codes for both centrally and peripheral inserted venous catheter. Therefore, whenever a catheter or port is placed with this procedure we use a status post catheter placement code. In ICD 9, we used to use V58.81, generally for these procedures. However, with the implementation of ICD 10, the V codes have been replaced by Z codes. Therefore, the new ICD 10 or Z code for V58.81 is Z45.2.
Z45.2 – Encounter for adjustment and management of vascular access device
Z codes for Chemotherapy or Radiotherapy
These are also important ICD codes. As per ICD coding guidelines, the encounter for Chemotherapy and Radiotherapy for Neoplasm should always be coded a Primary diagnosis. There is no difference between ICD 9 and ICD 10 guidelines, only t he codes have changed. So, in ICD 9 we use to have V codes for coding encounter for Chemotherapy or Radiotherapy.
V58.0- Encounter for antineoplastic radiation therapy
V58.11 – Encounter for antineoplastic chemotherapy
However, in ICD 10 we will be using again Z codes for these codes. The new Z codes for encounter for Chemotherapy and Radiotherapy should always be used as primary diagnosis and followed by the neoplasm code for which the therapy is done.
Z51.0 – Encounter for antineoplastic radiation therapy
Z51.11 – Encounter for antineoplastic chemotherapy
Renal Dialysis Status Z codes
Patients with Chronic kidney diseases (CKD) will be on hemodialysis especially the end stage renal disease (N18.6) patients. So, patient on renal dialysis will be coded with hemodialysis status code. For coding status code, we should code the CKD first followed by renal dialysis code. The ICD 9 code for renal dialysis is V45.11. This code should not be used as Primary code as per coding guidelines. There should a primary diagnosis like ESRD to support the renal dialysis status code. In ICD 10, this code has been replaced by the new ICD 10 code.
Z99.2 – Dependence on renal dialysis
Joint Replacement Status Z codes
There are specific joint replacement codes for each joint. We use to use V54.81 ICD 9 code for patient coming for Encounter for Joint Replacement followed by V43 series to code the specific joint code. Same follows with the ICD 10 codes, but here we will have laterality specific codes for joints. ICD 10 we have specific code for right, left, bilateral and unspecific codes for extremities or joints. Therefore, in ICD 10 we have to choose the most specific code for coding joint replacement code. For example if there is Encounter for hip joint replacement, below are the new ICD 10 codes will be used for hip joint replacement.
Primary code for Joint Replacement
Z47.1 – Aftercare following joint replacement surgery
Depending on which side of hip is being replaced, we will use the most specific secondary diagnosis code.
Z96.641 – Presence of right artificial hip joint
Z96.642 – Presence of left artificial hip joint
Z96.643 – Presence of Bilateral artificial hip joint
Z96.649 – Presence of unspecified artificial hip joint