When to use ICD 10 Status Z codes as Secondary diagnosis
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. The new Z codes which have been replaced with V codes, have now completely changed in ICD 10. Earlier we had limited V codes for status codes, but in ICD 10 codes we have “n” number of Z codes. For example, the pregnancy chapter itself has Z3A category codes for weeks of gestation. This itself shows how much specific ICD 10 codes are. But, still many medical coders are not aware of coding 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.
Read also: How to become perfect in coding Z codes
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.
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.