Factors influencing health status and contact with health services-ICD-10-CM GUIDELINES BY BHARATH KUMAR MEDESUN STUDENT

1. FACTORS
INFLUENCING HEALTH
STATUS AND CONTACT
WITH HEALTH
SERVICES

2. INTRODUCTION
• Z codes are used as primary codes or secondary codes
• USE OF Z CODES IN ANY HEALTHCARE SETTING
• Z codes are for use in any healthcare setting.Z codes
may be used as either a first-listed or secondary code,
depending on the circumstances of the encounter.
certain z codes may only be used as first listed or
primary code.

3. • Z codes indicate reason for an encounter.
• These are not procedure codes.A corresponding
procedure code must accompany a Z code to describe
any procedure performed.

4. • Use codes from category z20 and z27 for patients who
have been exposed to the disease but who have no
signs and symptoms of the disease. you can use them
as a primary codes for testing encounters or as
secondary codes to supply information about risk.
• Use z23 as a secondary code when the patient has the
inoculation as part of a preventive healthcare visit.

5. Status codes
• A status code offers information about the patient that
may affect treatment,such as presence of a prosthetic
don’t confuse status codes with history codes, which you
use when the patient does not have the condition
anymore.
• When a code description contains status code
information don’t report status code separately

6. • Drug use; do not use codes from category z79 for
patients addicted to drugs or in
detoxification/maintainence programmes.use drug
dependence code instead.
• Genetic susceptibility assign codes from category z15
only as a secondary code and if the patient has a gene
that increases the patient risk for that disease.

7. • The z code section includes codes for both personal
history and family history
• Personal history codes typically apply to conditions the
patient used to have that have the potential to occur
again.family history codes represent conditions found in
the patients family suggesting the patient may be at
higher risk for the disease.

8. • Use the screening z codes for tests on patients with no
signs or symptoms of the disease being tested for. if a
patient has a sign or symptom then the test is diagnostic
and a screening code is not appropriate.use the sign or
symptom code for the test encounter instead.

9. • A code categories include the following
1. Z11-encounter for screening for infectious and parasitic
diseases
2. Z12-encounter for screening for malignant neoplasms
3. Z13-encounter for screening for other diseases and
disorders.except z13.9 encounter for screening
unspecified
4. Z36-encounter for antenatal screening for mother

10. • Use observation codes only as the primary diagnosis
code. other codes may be added only if they are
unrelated to the reason for observation.

11. • Code Z21 on a medical record indicates that a patient is
HIV positive and developed AIDS.
• A code from category z22 on a medical record indicates
that the person is capable of transmitting the infection of
an organism and is showing symptoms of that disease

12. • Code z33.1 pregnant state, incidental should always be
assigned as secondary/additional diagnosis.
• A code from z 79 category may be assigned if a patient
is receiving a medication for an extended period as a
prophylactic measure
• Personal history z codes explain a patients past medical
condition that no longer exists and is not receiving any
treatment and that has no potential for recurrence.

13. • Family history z codes may be used with screening
codes and personal history z codes with follow-up codes.
• History z codes are used on any medical record
regardless of reason for visit
• Testing a person to rule out or confirm a suspected
condition because the patient has some signs or
symptoms is considered as screening examination and
the visit should be coded with a code for screening

14. • A screening code is not necessary if the screening is
inherent to a routine examination
• If a condition is confirmed during screening the z code
for screening should not be coded instead only the
confirmed diagnosis should be coded
• Observation codes are to be used as additional
diagnosis always

15. • Status z codes may be used with aftercare z codes
• A status z code should not be used along with a z code
for aftercare if the aftercare code indicates the type of
status
• A follow up z code indicates that visit is for ongoing care
of a healing condition or its sequelae.

16. • Z code for follow up examination after surgery should be
coded with history code for the condition treated and
follow up code should be sequenced first followed by the
history code.
• If a condition treated is found to have recurred on a
follow up visit then code only for the recurred condition

17. • Autologus organ donation conditions may be coded with
a code from category z52
• Counseling z codes are not reported with a diagnosis
code when the counseling component of care is
considered integral to standard treatment
• Codes from z37 category should always assign as
secondary codes

18. • Codes from z34 category are always used as primary
codes
• A code from category z40.0 encounter for prophylactic
surgery for risk factors related to neoplasms may be
assigned for the removal of ovaries for the treatment of
uterine cancer.

19. LIST OF SECTIONS
• Z00-Z13 Persons encountering health services for
examinations
• Z14-Z15 Genetic carrier and genetic susceptibility to
disease
• Z16-Z16 Resistance to antimicrobial drugs
• Z17-Z17 Estrogen receptor status
• Z18-Z18 Retained foreign body fragments

20. • Z19-Z19 Hormone sensitivity malignancy status
• Z20-Z29 Persons with potential health hazards related
to communicable diseases
• Z30-Z39 Persons encountering health services in
circumstances related to reproduction
• Z40-Z53 Encounters for other specific health care
• Z55-Z65 Persons with potential health hazards related
to socioeconomic and psychosocial circumstances

21. • Z66-Z66 Do not resuscitate status
• Z67-Z67 Blood type
• Z68-Z68 Body mass index (BMI)
• Z69-Z76 Persons encountering health services in other
circumstances
• Z77-Z99 Persons with potential health hazards related
to family and personal history and certain conditions
influencing health status

22. examples
• Ex; 45-year old male presented for general examination.
O/E physician noticed pedal edema and advised further
workup
• Ans;z00.01,R60.0
• Ex; A patient is referred to the radiology department for a
chest x-ray as part of a routine physical examination
noted decreased lung sounds on examination
• Ans;z00.01

23. • Ex;well-child visit the clinician notes enlarged lymph
nodes.code the exam with abnormal findings and in
addition add the code for enlarged cervical lymph nodes
• Ans;Z00.121,R59.0

24. • EX;Encounter for examination of eyes and vision without
abnormal findings
• Ans;Z01.00
• Ex; Encounter for examination of eyes and vision with
abnormal findings
• Ans;Z01.01

25. • Resistance to antimicrobial drugs-Z16
• Code first the infection
• MRSA code from chapter-1 resistance to
antibiotics,antifungals,antivirals etc.assign the code from
category Z16.
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26. THANK YOU