From A to Z-Codes Matter

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2 From A to Z-Codes Matter Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, FAHIMA While ALL ICD-10-CM codes are important, the Z-codes in ICD-10-CM are frequently considered step-children, supplemental codes that are typically relegated to the end of the list of codes. They even appear in the last chapter of the ICD-10-CM codeset. It is essential to remember that the inpatient electronic claim allows for up to 25 diagnosis codes. If you are striving to achieve optimum credit in CMS quality measures and other initiatives, carefully review your final list of codes to assure these codes are included in the top 25 when possible. These codes DO matter as they impact the patient s severity of illness and/or risk of mortality. A handful of these Z-codes affect reimbursement as CC s in the MS-DRG system, but many more impact risk-adjusted methodologies used by CMS as HCCs (codes in Hierarchical Condition Categories), and other organizations who publish hospital report cards. Z-codes can also impact the severity of illness and risk of mortality levels under APR-DRGs. Some Z-codes imply greater severity while other codes, such as those for DNR and Transplant Status exclude patients from reporting in select measures such as Patient Safety Indicators (PSI). Reassess ICD-10 based hospital coding policies to assure that expectations for Z-code reporting are clear. Potentially significant Z-codes are listed in the table that follows. Do your internal policies outline the expectation that coders assign them? Z codes with impact to MS- DRGs, HCCs and the immunocompromised category of Patient Safety Indicators (PSI) are included in the list below. Other Z codes that appear on this list can impact other DRG methodologies and risk adjustment for a variety of publicly reported hospital report cards. In other words everything on this list is important! 1

3 Z006 Z1611 Z21 Z372 Z373 Z374 Z3750 Z3751 Z3752 Z3753 Z3754 Z3759 Z3760 Z3761 Z3762 Z3763 Z3764 Z3769 Z377 Z430 Z431 Z432 Z433 Z434 Z435 Z436 Z438 Z439 Z44101 Z44102 Z44109 Z44111 Z44112 Z44119 Z44121 Z44122 Z44129 Z4821 Z4822 Z4823 Z4824 Z48280 Z48288 Z48290 Z48298 Z4901 Z4902 Z4931 Z4932 Encounter for exam for normal comparison & control in clinical research program Resistance to penicillins Asymptomatic HIV infection status Twins, both liveborn Twins, one liveborn and one stillborn Twins, both stillborn Multiple births, unspecified, all liveborn Triplets, all liveborn Quadruplets, all liveborn Quintuplets, all liveborn Sextuplets, all liveborn Other multiple births, all liveborn Multiple births, unspecified, some liveborn Triplets, some liveborn Quadruplets, some liveborn Quintuplets, some liveborn Sextuplets, some liveborn Other multiple births, some liveborn Other multiple births, all stillborn Encounter for attention to tracheostomy Encounter for attention to gastrostomy Encounter for attention to ileostomy Encounter for attention to colostomy Encounter for attention to other artificial openings of digestive tract Encounter for attention to cystostomy Encounter for attention to other artificial openings of urinary tract Encounter for attention to other artificial openings Encounter for attention to unspecified artificial opening Encounter for fitting and adjustment of unspecified right artificial leg Encounter for fitting and adjustment of unspecified left artificial leg Encounter for fitting and adjustment of unspecified artificial leg, unspecified leg Encounter for fitting and adjustment of complete right artificial leg Encounter for fitting and adjustment of complete left artificial leg Encounter for fitting and adjustment of complete artificial leg, unspecified leg Encounter for fitting and adjustment of partial right artificial leg Encounter for fitting and adjustment of partial left artificial leg Encounter for fitting and adjustment of partial artificial leg, unspecified leg Encounter for aftercare following heart transplant Encounter for aftercare following kidney transplant Encounter for aftercare following liver transplant Encounter for aftercare following lung transplant Encounter for aftercare following heart-lung transplant Encounter for aftercare following multiple organ transplant Encounter for aftercare following bone marrow transplant Encounter for aftercare following other organ transplant Encounter for fitting and adjustment of extracorporeal dialysis catheter Encounter for fitting and adjustment of peritoneal dialysis catheter Encounter for adequacy testing for hemodialysis Encounter for adequacy testing for peritoneal dialysis 2

4 Z515 Z5331 Z5332 Z5333 Z5339 Z66 Z681 Z6825 Z6826 Z6827 Z6828 Z6829 Z6830 Z6831 Z6832 Z6833 Z6834 Z6835 Z6836 Z6837 Z6838 Z6839 Z6841 Z6842 Z6843 Z6844 Z6845 Z69010 Z69011 Z69020 Z7401 Z7682 Z77090 Z781 Z7901 Z7902 Z794 Z7951 Z7952 Z7982 Z79890 Z823 Z8249 Z8500 Z8501 Z85020 Z85028 Z85030 Z85038 Encounter for palliative care Laparoscopic procedure converted to open Thoracoscopic procedure converted to open Arthroscopic procedure converted to open Other specified procedure converted to open Do not resuscitate Body mass index (BMI) 19.9 or less, adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) , adult Body mass index (BMI) 70 or greater, adult Encounter for mental health services for victim of parental child abuse Encounter for mental health services for perpetrator of parental child abuse Encounter for mental health services for victim of nonparental child abuse Bed confinement status Awaiting organ transplant status Contact with and (suspected) exposure to asbestos Physical restraint status Long term (current) use of anticoagulants Long term (current) use of antithrombotics / antiplatelets Long term use of insulin Long term use of inhaled steroids Long term use of systemic steroids Long term use of aspirin Hormone replacement therapy Family history of stroke Family history of ischemic heart disease and other diseases of the circulatory system Personal history of malignant neoplasm of unspecified digestive organ Personal history of malignant neoplasm of esophagus Personal history of malignant carcinoid tumor of stomach Personal history of other malignant neoplasm of stomach Personal history of malignant carcinoid tumor of large intestine Personal history of other malignant neoplasm of large intestine 3

5 Z85040 Z85048 Z8505 Z85060 Z85068 Z8507 Z8509 Z85110 Z85118 Z8512 Z8520 Z8521 Z8522 Z85230 Z85238 Z8529 Z853 Z8540 Z8541 Z8542 Z8543 Z8544 Z8545 Z8546 Z8547 Z8548 Z8549 Z8550 Z8551 Z85520 Z85528 Z8553 Z8554 Z8559 Z856 Z8571 Z8572 Z8579 Z85810 Z85818 Z85819 Z85820 Z85821 Z85828 Z85830 Z85831 Z85840 Z85841 Z85848 Personal history of malignant carcinoid tumor of rectum Personal history of other malignant neoplasm of rectum Personal history of malignant neoplasm of liver Personal history of malignant carcinoid tumor of small intestine Personal history of other malignant neoplasm of small intestine Personal history of malignant neoplasm of pancreas Personal history of malignant neoplasm of other digestive organs Personal history of malignant carcinoid tumor of bronchus and lung Personal history of other malignant neoplasm of bronchus and lung Personal history of malignant neoplasm of trachea Personal history of malignant neoplasm of unspecified respiratory organ Personal history of malignant neoplasm of larynx Personal history of malignant neoplasm of nasal cavities, middle ear, and accessory sinuses Personal history of malignant carcinoid tumor of thymus Personal history of other malignant neoplasm of thymus Personal history of malignant neoplasm of other respiratory and intrathoracic organs Personal history of malignant neoplasm of breast Personal history of malignant neoplasm of unspecified f genital organ Personal history of malignant neoplasm of cervix uteri Personal history of malignant neoplasm of other parts of uterus Personal history of malignant neoplasm of ovary Personal history of malignant neoplasm of other female genital organs Personal history of malignant neoplasm of unspecified male genital organs Personal history of malignant neoplasm of prostate Personal history of malignant neoplasm of testis Personal history of malignant neoplasm of epididymis Personal history of malignant neoplasm of other male genital organs Personal history of malignant neoplasm of unspecified urinary tract organ Personal history of malignant neoplasm of bladder Personal history of malignant carcinoid tumor of kidney Personal history of other malignant neoplasm of kidney Personal history of malignant neoplasm of renal pelvis Personal history of malignant neoplasm of ureter Personal history of malignant neoplasm of other urinary tract organ Personal history of leukemia Personal history of Hodgkin lymphoma Personal history of non-hodgkin lymphomas Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues Personal history of malignant neoplasm of tongue Personal history of malignant neoplasm of other sites of lip, oral cavity, and pharynx Personal history of malignant neoplasm of unspecified site of lip, oral cavity and pharynx Personal history of malignant melanoma of skin Personal history of Merkel cell carcinoma Personal history of other malignant neoplasm of skin Personal history of malignant neoplasm of bone Personal history of malignant neoplasm of soft tissue Personal history of malignant neoplasm of eye Personal history of malignant neoplasm of brain Personal history of malignant neoplasm of other parts of nervous tissue 4

6 Z85850 Z85858 Z8589 Z859 Z86711 Z86718 Z8673 Z8674 Z8679 Z8701 Z87891 Z89411 Z89412 Z89419 Z89421 Z89422 Z89429 Z89431 Z89432 Z89439 Z89441 Z89442 Z89449 Z89511 Z89512 Z89519 Z89611 Z89612 Z89619 Z906 Z9115 Z9119 Z92241 Z9282 Z930 Z931 Z932 Z933 Z934 Z9350 Z9351 Z9352 Z9359 Z936 Z938 Z939 Z940 Z941 Z942 Personal history of malignant neoplasm of thyroid Personal history of malignant neoplasm of other endocrine glands Personal history of malignant neoplasm of other organs and systems Personal history of malignant neoplasm, unspecified Personal history of pulmonary embolism Personal history of other venous thrombosis and embolism Personal history of TIA and cerebral infarction without residual deficits Personal history of sudden cardiac arrest Personal history of other diseases of the circulatory system Personal history of pneumonia (recurrent) Personal histroy of nicotine dependence Acquired absence of right great toe Acquired absence of left great toe Acquired absence of unspecified great toe Acquired absence of other right toe Acquired absence of other left toe Acquired absence of unspecified toe Acquired absence of right foot Acquired absence of left foot Acquired absence of unspecified foot Acquired absence of right ankle Acquired absence of left ankle Acquired absence of unspecified ankle Acquired absence of right leg below knee Acquired absence of left leg below knee Acquired absence of unspecified leg below knee Acquired absence of right leg above knee Acquired absence of left leg above knee Acquired absence of unspecified leg above knee Acquired absence of other parts of urinary tract Patient's noncompliance with renal dialysis Pt's noncompliance with other medical treatment and regimen Personal hx systemic steroid therapy Status post tpa in a different facility within the last 24 hours prior to admission to current facility Tracheostomy status Gastrostomy status Ileostomy status Colostomy status Other artificial openings of gastrointestinal tract status Unspecified cystostomy status Cutaneousvesicostomy status Appendicovesicostomy status Other cystostomy status Other artificial openings of urinary tract status Other artificial opening status Artificial opening status, unspecified Kidney transplant status Heart transplant status Lung transplant status 5

7 Z943 Z944 Z946 Z9481 Z9482 Z9483 Z9484 Z9489 Z949 Z950 Z951 Z952 Z955 Z95810 Z95811 Z95812 Z95820 Z95828 Z980 Z9861 Z9911 Z9912 Z992 Z993 Z9981 Heart and lungs transplant status Liver transplant status Bone transplant status Bone marrow transplant status Intestine transplant status Pancreas transplant status Stem cells transplant status Other transplanted organ and tissue status Transplanted organ and tissue status, unspecified Presence of cardiac pacemaker Presence of aortocoronary bypass graft Presence of prosthetic heart valve Presence of coronary angioplasty implant and graft Presence of automatic (implantable) cardiac defibrillator Presence of heart assist device Presence of fully implantable artificial heart Peripheral vascular angioplasty status with implants and grafts Presence of other vascular implants and grafts Intestinal bypass and anastomosis status Coronary angioplasty status Dependence on respirator [ventilator] status Encounter for respirator [ventilator] dependence during power failure Dependence on renal dialysis Dependence on wheelchair Dependence on supplemental oxygen Be sure to research the ICD-10-CM Official Guidelines for Coding and Reporting for proper use of these codes. See Section 1.C.21.