Nov 2017 FromAtoZCodesMatter
From A to Z-Codes Matter Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, FAHIMA The implementation of ICD-10 brought tens of thousands of new codes. Ranging from A to Z, they portray added specificity to explain the patient s condition. While ALL of the codes are important, the Z-codes in ICD-10-CM (once V-codes in ICD-9-CM) have long been 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 important 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 ( CC ), HCCs and the immunocompromised category (IMM) of Patient Safety Indicators (PSI) are marked 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
Z006 Z1611 Encounter for exam for normal comparison & control in clinical research program Resistance to penicillins Z21 Asymptomatic HIV infection status x Z372 Twins, both liveborn x Z373 Twins, one liveborn and one stillborn x Z374 Twins, both stillborn x Z3750 Multiple births, unspecified, all liveborn x Z3751 Triplets, all liveborn x Z3752 Quadruplets, all liveborn x Z3753 Quintuplets, all liveborn x Z3754 Sextuplets, all liveborn x Z3759 Other multiple births, all liveborn x Z3760 Multiple births, unspecified, some liveborn x Z3761 Triplets, some liveborn x Z3762 Quadruplets, some liveborn x Z3763 Quintuplets, some liveborn x Z3764 Sextuplets, some liveborn x Z3769 Other multiple births, some liveborn x Z377 Other multiple births, all stillborn x Z430 Encounter for attention to tracheostomy x Z431 Encounter for attention to gastrostomy x x Z432 Encounter for attention to ileostomy x Z433 Encounter for attention to colostomy x Z434 Encounter for attention to other artificial openings of digestive tract x Z435 Encounter for attention to cystostomy x Z436 Encounter for attention to other artificial openings of urinary tract x Z438 Encounter for attention to other artificial openings x Z439 Encounter for attention to unspecified artificial opening x Z44101 Encounter for fitting and adjustment of unspecified right artificial leg x Z44102 Encounter for fitting and adjustment of unspecified left artificial leg x Z44109 Encounter for fitting and adjustment of unspecified artificial leg, unspecified leg x Z44111 Encounter for fitting and adjustment of complete right artificial leg x Z44112 Encounter for fitting and adjustment of complete left artificial leg x Z44119 Encounter for fitting and adjustment of complete artificial leg, unspecified leg x Z44121 Encounter for fitting and adjustment of partial right artificial leg x Z44122 Encounter for fitting and adjustment of partial left artificial leg x Z44129 Encounter for fitting and adjustment of partial artificial leg, unspecified leg x Z4821 Encounter for aftercare following heart transplant x x x Z4822 Encounter for aftercare following kidney transplant x x x Z4823 Encounter for aftercare following liver transplant x x x Z4824 Encounter for aftercare following lung transplant x x x Z48280 Encounter for aftercare following heart-lung transplant x x x Z48288 Encounter for aftercare following multiple organ transplant x x Z48290 Encounter for aftercare following bone marrow transplant x x x 2
Z48298 Encounter for aftercare following other organ transplant x x Z4901 Encounter for fitting and adjustment of extracorporeal dialysis catheter x x Z4902 Encounter for fitting and adjustment of peritoneal dialysis catheter x x Z4931 Encounter for adequacy testing for hemodialysis x x Z4932 Encounter for adequacy testing for peritoneal dialysis x Z515 Z66 Encounter for palliative care Do not resuscitate Z681 Body mass index (BMI) 19.9 or less, adult x Z6841 Body mass index (BMI) 40.0-44.9, adult x x Z6842 Body mass index (BMI) 45.0-49.9, adult x x Z6843 Body mass index (BMI) 50-59.9, adult x x Z6844 Body mass index (BMI) 60.0-69.9, adult x x Z6845 Body mass index (BMI) 70 or greater, adult x x Z69010 Encounter for mental health services for victim of parental child abuse x Z69011 Encounter for mental health services for perpetrator of parental child abuse x Z69020 Encounter for mental health services for victim of nonparental child abuse x Z7682 Awaiting organ transplant status x Z77090 Contact with and (suspected) exposure to asbestos Z781 Physical restraint status x Z7901 Z7902 Long term (current) use of anticoagulants Long term (current) use of antithrombotics / antiplatelets Z794 Long term use of insulin x Z7952 Z7982 Z823 Z8249 Z8500 Z8501 Z85020 Z85028 Z85030 Z85038 Z85040 Z85048 Z8505 Z85060 Z85068 Z8507 Z8509 Z85110 Z85118 Z8512 Z8520 Z8521 Long term use of systemic steroids Long term use of aspirin 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 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 3
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 Z85850 Z85858 Z8589 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 female 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 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 4
Z859 Personal history of malignant neoplasm, unspecified Z86711 Z86718 Z8673 Personal history of pulmonary embolism Personal history of other venous thrombosis and embolism Personal history of TIA and cerebral infarction without residual deficits Z8674 Personal history of sudden cardiac arrest x Z8679 Z8701 Z87891 Personal history of other diseases of the circulatory system Personal history of pneumonia (recurrent) Personal histroy of nicotine dependence Z89411 Acquired absence of right great toe x Z89412 Acquired absence of left great toe x Z89419 Acquired absence of unspecified great toe x Z89421 Acquired absence of other right toe x Z89422 Acquired absence of other left toe x Z89429 Acquired absence of unspecified toe x Z89431 Acquired absence of right foot x Z89432 Acquired absence of left foot x Z89439 Acquired absence of unspecified foot x Z89441 Acquired absence of right ankle x Z89442 Acquired absence of left ankle x Z89449 Acquired absence of unspecified ankle x Z89511 Acquired absence of right leg below knee x Z89512 Acquired absence of left leg below knee x Z89519 Acquired absence of unspecified leg below knee x Z89611 Acquired absence of right leg above knee x Z89612 Acquired absence of left leg above knee x Z89619 Acquired absence of unspecified leg above knee x Z906 Acquired absence of other parts of urinary tract x Z9115 Patient's noncompliance with renal dialysis x Z9282 Status post tpa in a different facility within the last 24 hours prior to admission to current facility Z930 Tracheostomy status x Z931 Gastrostomy status x Z932 Ileostomy status x Z933 Colostomy status x Z934 Other artificial openings of gastrointestinal tract status x Z9350 Unspecified cystostomy status x Z9351 Cutaneousvesicostomy status x Z9352 Appendicovesicostomy status x Z9359 Other cystostomy status x Z936 Other artificial openings of urinary tract status x Z938 Other artificial opening status x Z939 Artificial opening status, unspecified x Z940 Kidney transplant status x x x Z941 Heart transplant status x x x Z942 Lung transplant status x x x Z943 Heart and lungs transplant status x x x x 5
Z944 Liver transplant status x x x Z946 Bone transplant status x Z9481 Bone marrow transplant status x x x Z9482 Intestine transplant status x x x Z9483 Pancreas transplant status x x x Z9484 Stem cells transplant status x x Z9489 Other transplanted organ and tissue status x x Z949 Transplanted organ and tissue status, unspecified Z950 Presence of cardiac pacemaker Z951 Presence of aortocoronary bypass graft Z952 Presence of prosthetic heart valve Z955 Presence of coronary angioplasty implant and graft Z95810 Presence of automatic (implantable) cardiac defibrillator Z95811 Presence of heart assist device x x Z95812 Presence of fully implantable artificial heart x x Z95820 Peripheral vascular angioplasty status with implants and grafts Z95828 Presence of other vascular implants and grafts Z9861 Coronary angioplasty status Z9911 Dependence on respirator [ventilator] status x x Z9912 Encounter for respirator [ventilator] dependence during power failure x x Z992 Dependence on renal dialysis x x Z9981 Dependence on supplemental oxygen x