We have now almost became familiar with the ICD 10 codes. We all are now familiar with the difference between the ICD 9 and ICD 10 codes. The new diagnosis codes are huge in numbers. The ICD 10 codes are more specific compared to ICD 9 codes. Also, the new terms like Excludes 1 and Excludes 2 helps in coding correct diagnosis codes. In ICD 10 codes, the most of the errors happens in sequencing the ICD 10 codes. If their are multiple diagnosis codes in a medical report, then the coders have to code the primary and secondary diagnosis correctly following the ICD 10 coding guidelines. Z codes, the most typical ICD 10 codes, creates lot of confusion. Earlier we have seen how we can differentiate between an aftercare and followup ICD 10 Z code. Today, we will checkout when the status Z codes should be used.

Many medical coders are not aware of coding guidelines for the status Z codes . Even if the coders know the Z codes, they will have confusion of whether it should be coded as Primary (Pdx) or Secondary (Sdx). So, let us put more light on this topic.

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When to use Z codes as Primary

The most common scenario to code the Z codes as Primary diagnosis are the Encounter codes. All the Encounter Z codes should be coded as Primary diagnosis. Below are few example of Encounter Z codes in ICD 10.

Z48.810 Encounter for surgical aftercare following surgery on the sense organs

Z48.811 Encounter for surgical aftercare following surgery on the nervous system

Z48.812 Encounter for surgical aftercare following surgery on the circulatory system

Z48.813 Encounter for surgical aftercare following surgery on the respiratory system

Z48.814 Encounter for surgical aftercare following surgery on the teeth or oral cavity

Z48.815 Encounter for surgical aftercare following surgery on the digestive system

Z48.816 Encounter for surgical aftercare following surgery on the genitourinary system

The above list of Z codes are to be used only as Primary diagnosis. Now, coming to the Status Z codes, medical coders needs to use status codes as secondary diagnosis with Encounter Z codes as primary. Let us understand this scenario in detail.

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Coding for status code of Coronary Artery Bypass

ICD 10 code Z95.1 is used for coding Presence of aortocoronary bypass graft. But we cannot code this Z code as primary. Hence as per ICD 10 coding guidelines code Z48.812, Encounter for surgical aftercare following surgery on the circulatory system, should be used to indicate the surgery for which the aftercare is being performed. Always remember a status code should not be used when the aftercare code indicates the type of status, for example Z43.0, Encounter for attention to tracheostomy, with Z93.0, Tracheostomy status. Since, Z43.0 already mentions about tracheostomy, Z93.0 will not be required. Below we have few more examples of Z93 codes.

Z93.1 – Gastrostomy status

Z93.2 -Ileostomy status

Z93.3 -Colostomy status

Z93.4 -Other artificial openings of gastrointestinal tract status

Same way if we are coding for Arthrodesis status Z98.1, we need to report first Z47.89 Encounter for other orthopedic aftercare, as the Primary diagnosis followed by Z98.1. This is the correct way of coding status Z codes. 

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Points to remember

It is not mandatory to code Encounter codes only as primary diagnosis for Status codes. You can use any disorder or diagnosis related to the status Z code as primary and then you can code the status code as secondary. For example, for code ESRD (End Stage Renal Disease) patient on dialysis, we have to code first the ESRD (N18.6) followed by the renal dialysis status (Z99.2) Z code, dependence of renal dialysis. This way we are following ICD 1o coding guidelines and coding the correct diagnosis codes as well.

You can use two or more Encounter Z codes together. In this case you might have to use some Encounter Z codes as secondary diagnosis.