Z Code (Z00 Z99) Coding and Guidelines

Z Code (Z00 – Z99) Coding and Guidelines
Written by Angela Buckley, CCS, CPC, CPMA, CPC-I, RMA

Problem and Goal
Problem:
 Z codes being reported without a first-listed diagnosis (Dx).
First-listed is also described as primary or principal diagnosis.
Goal:
 Recognize which Z codes can be reported as first-listed
diagnosis.
 Recognize which Z codes are reported as a secondary
diagnosis.
What Are Z Codes
 Z codes represent reasons for specific encounters and are found in Chapter 21 of
ICD-10.
 Certain Z codes may only be reported as the first-listed Dx and should never be
reported in any position other the primary position.
 Some Z codes cannot be first-listed.
 Other Z codes may be used as either a first-listed or secondary Dx, depending on the
circumstances of the encounter.
Use of Z Codes
 Z codes (other reasons for healthcare encounters) may be
assigned as appropriate to further explain the reason for
presenting for healthcare services, including transfers
between healthcare facilities. The ICD-10 Official Guidelines
for Coding and Reporting identify which codes may be
assigned as first-listed or secondary (depending on the
circumstances).
 Assign as many codes as necessary to fully explain the

healthcare encounter.
Commonly Reported Categories of Z Codes
 Contact/Exposures
 Status
 History (of)
 Screening
 Observation
 Encounters for obstetrical and reproductive services
 Newborns and infants
 Routine and administrative examinations
 Miscellaneous Z codes
 Nonspecific Z codes
 Z codes that may only be first-listed diagnosis
Examples Of Z Codes That Are First-Listed
Except when there are multiple encounters on the same day and the medical records for the encounter are combined
Z00 Encounter for general examination without complaint, suspected or reported diagnosis
Except: Z00.6 Encounter for examination for normal comparison and control in clinical research
program
Z01 Encounter for other special examination without complaint, suspected or reported diagnosis
Z02 Encounter for administrative examination
Z03 Encounter for medical observation for suspected diseases and conditions ruled out
Z04 Encounter for examination and observation for other reasons
Z33.2 Encounter for elective termination of pregnancy
Z31.81 Encounter for male factor infertility in female patient
Z31.82 Encounter for Rh incompatibility status
Z31.83 Encounter for assisted reproductive fertility procedure cycle
Z31.84 Encounter for fertility preservation procedure
Z34 Encounter for supervision of normal pregnancy
Z39 Encounter for maternal postpartum care and examination
Z76.1 Encounter for health supervision and care of foundling
Z76.2 Encounter for health supervision and care of other healthy infant and child
This is not an all-inclusive list of first-listed Z codes.
These are examples only and TriCore does not encourage use of these codes unless they describe the patient’s condition and are documented in the
patient’s chart.
Examples Of Z Codes That Cannot Be First-Listed
 Pregnant state, incidental (Z33.1) cannot be first-listed as per the description of the code it is
incidental to the reason why the patient was seen. A diagnosis for the circumstances of the
encounter should be listed first.
 Weeks of gestation (Z3A.00 – Z3A.49) requires a diagnosis from Chapter 15 Pregnancy,

Childbirth and the Puerperium.
 BMI (Z68.20 – Z68.54) should only be assigned when the associated diagnosis (such as
overweight or obesity) meets the definition of reportable diagnosis.
This is not an all-inclusive list of all Z codes that cannot be first-listed.
These are examples only and TriCore does not encourage use of these codes unless they describe the patient’s condition and are documented in the
patient’s chart.
Medicare
 Will not pay a laboratory claim if non-covered Dx’s are reported according to Medicare’s National Coverage Determinations
(NCD) policy and Local Coverage Determinations (LCD).
 Commonly reported non-covered Z codes

Z00.00
Z02.79
Z02.89
Z02.9
Z11.3
Z11.4
Z11.59
Z13.220
Z13.89
Z13.9
This is not an all-inclusive list of non-covered Z codes. Please check the NCD’s/LCD’s for a full list of codes.
These are examples only and TriCore does not encourage use of these codes unless they describe the patient’s condition and are
documented in the patient’s chart.
Resources
 ICD-10-CM Coding Guidelines FY 2019 (October 1, 2018 - September
30, 2019
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2019-
ICD10-Coding-Guidelines-.pdf
 ICD-10-CM Coding Book

https://www.cms.gov/medicare/coding/icd10/2019-icd-10-cm.html
 CMS NDC
http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDs
ICD10.htm

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Z Code (Z00 – Z99) Coding and Guidelines

Written by Angela Buckley, CCS, CPC, CPMA, CPC-I, RMA

 Some Z codes cannot be first-listed.

 Assign as many codes as necessary to fully explain the

 Weeks of gestation (Z3A.00 – Z3A.49) requires a diagnosis from Chapter 15 Pregnancy,

This is not an all-inclusive list of all Z codes that cannot be first-listed.

 Commonly reported non-covered Z codes

 ICD-10-CM Coding Book

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