Are Z Codes Used For Problem Visits

Bob Roberts
• Friday, 18 December, 2020
• 8 min read

For more information, visit our help center and read How To: View, Add, and Delete Diagnosis Codes. They’d rather not risk wasting their client’s time submitting a claim if it may get rejected by the insurance company.


These are codes that acknowledge emotional or behavioral symptoms while deferring a specific diagnosis for up to six months. We’ll cover other codes in future posts, so make sure you subscribe to the TherapyNotes™ blog below for more helpful information.

ICD-10-CM diagnosis codes support medical necessity by identifying the reason for the patient encounter, which may include an acute injury or illness, a chronic health condition, or signs and symptoms (e.g., pain, cough, shortness of breath, etc.) When a patient presents for health screening services without a specific complaint, however, it’s time to call on Codes.

Screening differs from diagnostic examination, in which testing occurs in a patient with signs and symptoms to rule out or confirm a suspected diagnosis. Example 1: A 60-year-old male patient presents to the outpatient radiology department for a lower gastrointestinal (GI) examination.

Ramesh has more than 11 years of experience in the management, medical coding, auditing, and revenue cycle sectors, and in coder and auditor calibration, new training module program creation, with multi specialty expertise in radiology, evaluation and management, and surgery. Note Z codes represent reasons for encounters.

This can arise in two main ways: (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Here are the most important tips to keep in mind regarding the use of aftercare codes in rehab therapy settings: However, not all ICD-10 diagnosis codes include the option to add a seventh character.

In this ICD10 Monitor article, Lauri Gray, HIT, CPC, writes, “Aftercare visit codes cover situations occurring when the initial treatment of a disease has been performed and the patient requires to be continued care during the healing or recovery phase, or care for the long-term consequences of the disease.” Post-op care falls into that bucket when the condition that precipitated the surgery no longer exists, but the patient still requires therapy care to return to a healthy level of function. In situations where it’s appropriate to use Codes, “aftercare codes are generally the first listed diagnosis,” Gray writes.

Let’s also assume that, as a result of the surgery, the patient is no longer suffering from osteoarthritis. If the line between acceptable and unacceptable uses of aftercare codes still seems a bit fuzzy, just remember that in most cases, you should only use aftercare codes if there’s no other way for you to express that a patient is on the “after” side of an aforementioned “before-and-after” event.

You may have chronic conditions addressed also and the may be listed on the claim, however when you are linking the diagnosis to the procedure/visit codes like the Z00.00 only to the preventive/wellness code no other pointer should be used. If the provider discovers an abnormality while performing the preventive encounter you may also list the abnormality and link that diagnosis only to an office visit and use the Z00.01 code for the preventive diagnosis.

I have a confusion with the Z00.00 DX code, Our Pediatric office is billing this with the Z00.129 routine child visit without abnormal findings and urinalysis was done on the same date of outpatient visit, my question is, can Z00.00 be billed for lab work for a 10-year-old? As the code states “Encounter for adult periodic examination and any associated laboratory and radiologic examinations” and I am not clear whether Z00.129 includes lab work.

Many payers will not pay for labs using the general exam code. In the movie world, prequels have a reputation for failing to match the glory of their predecessors (The Hangover Part III, anyone?).

This allows you to paint a complete, accurate, and detailed picture of the patient and his or her situation. Thus, if you're referring physician did not send a medical diagnosis, I would suggest reaching out to obtain one, as that will help ensure you code as thoroughly as possible.

That way, the codes don’t have to be listed out individually, which would take up a lot of space. We’ve received numerous questions about how to code in very specific patient scenarios.

While we are not trained coders, we can say that with ICD-10, you are encouraged to first code for the underlying condition causing such spinal symptoms. Whenever possible, you should first code for the underlying condition that is causing the symptom (which in this case is stiffness).

Here is a resource that lists ICD-10 codes for common spinal conditions. While there is not an ICD-10 code for impaired balance, there are several options that provide a much higher degree of specificity.

These include the codes listed in the R26 (Abnormalities of gait and mobility) and R27 (Other lack of coordination) series. To select the code that best describes the patient’s condition, you’ll need to use your clinical judgment.

If the patient has a confirmed underlying diagnosis (i.e., the condition actually causing the back pain), then you should code for that first. Snag your free copy of the One ICD-10 FAQ to Rule Them All: The Definitive Resource for Physical Therapists here.

Remember, external cause codes (like those that denote accidents) are optional. Just make sure you accurately record any potentially relevant information within the patient’s documentation.

While you are encouraged to submit external cause codes when possible, they are not required. We don’t anticipate claims being denied for having “extra” codes ; that said, if and when ICD-10-related denials start to occur, we’ll keep our Blog readers informed on the most common reasons behind those denials.

Per the official ICD-10 coding guidelines (which you can find here), “The aftercare Codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. The ICD-10 coding guidelines seem to suggest that the order may change based on the specific context of the patient’s situation.

If the condition that caused the patient to undergo surgery no longer exists, then you should not code for it. While there is not an aftercare code for every single surgery, in many cases, the proper way to designate the phase of treatment (i.e., indicate that the patient is receiving aftercare) is to code for the original acute injury and add the appropriate seventh character (which in this case, would be D).

So, if, for example, the patient originally strained his or her right rotator cuff, you would indicate that you are providing aftercare by using the code S46.011D, Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter. For more information on coding for aftercare, check out this blog post.

You can submit up to four diagnosis code pointers per service line, which means you can point to up to four diagnoses. Because the standard CFA claim form allows space for only four diagnosis pointers per service line, some billing systems only pull the four most relevant diagnosis codes through to Box 21 on the claim form.

It’s up to you and your clinical judgement to determine if that code is the one that best describes the patient’s condition. Our system has defaulted the insurance types Auto and Other to ICD-9 codes.

Also, this is a good time to correct categorized insurance types to avoid this problem in the future. Hopefully, this blog post left you more satisfied than that time you shelled out your hard-earned canola to see Home Alone 3 in the theater.

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