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CODING ALERT

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

By Judy Monestime  bio

Chapter 21 in ICD-10-CM contains codes for factors influencing health status and contact with health services. There are differences in ICD-10-CM from what is currently found in ICD-9-CM.

Some categories in Chapter 21 have rephrased titles to better reflect the situations the codes classify. For example, elective, legal, or therapeutic abortions have been moved from ICD-9-CM Chapter 11, Complications of Pregnancy, Childbirth, and the Puerperium, to ICD-10-CM Chapter 21. Also, several codes have been expanded in ICD-10-CM; for example, personal and family history codes have been expanded.

This chapter contains the following blocks:

Z00-Z13 Persons encountering health services for examinations

Z14-Z15 Genetic carrier and genetic susceptibility to disease

Z16 Resistance to antimicrobial drugs

Z17 Estrogen receptor status

Z18 Retained foreign body fragments

Z20-Z28 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 healthcare

Z55-Z65 Persons with potential health hazards related to socioeconomic and psychosocial circumstances

Z66 Do not resuscitate status

Z67 Blood type

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

Codes have been added for concepts that currently do not exist in ICD-9-CM. For example, category Z67 identifies the patient’s blood type.

Also, category Z68, Body mass index (BMI), is divided into adult and pediatric codes. The BMI adult codes are for use for persons 21 years or older. BMI pediatric codes are for use for persons 2-20 years of age.

However, there are also concepts that existed in ICD-9-CM that no longer exist in ICD-10-CM. For example, there is no comparable category in ICD-10-CM to ICD-9-CM category V57, care involving use of rehabilitation procedures. For encounters for rehabilitative therapy, report the underlying condition for which therapy is being provided (such as an injury) with the appropriate seventh character indicating subsequent encounter. This change greatly affects certain settings providing aftercare.

The note at the beginning of this chapter has been modified from what it states in ICD-9-CM. Here is the note:

  • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury, or external cause classifiable to categories A00-Y89 are recorded as ‘diagnoses’ or ‘problems’. 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.

Coding guidelines specific to this chapter include:

Coding Guideline IV.E. Encounters for Circumstances Other than a Disease or Injury      

ICD-10-CM provides codes to deal with encounters for circumstances other than a disease or injury. The Factors Influencing Health Status and Contact with the Health Services codes (Z00-99) is provided to deal with occasions when circumstances other than a disease or injury are recorded as diagnosis or problems.

Coding Guideline I.C.21.c.2. Inoculations and Vaccinations

Code Z23 is for encounters for inoculations and vaccinations. It indicates that a patient is being seen to receive a prophylactic inoculation against a disease. Procedure codes are required to identify the actual administration of the injection and the type(s) of immunization(s) given. Code Z23 may be used as a secondary code if the inoculation is given as a routine part of preventive healthcare, such as a well-baby visit.

Let’s practice! How do you code the following encounter?

A 65-year-old white female sees her physician for an annual visit. She has her annual Pap smear and flu shot for the season. What diagnoses codes would the physician report?

  • Z01.419 Examination (for) (following) (general) (of) (routine), annual (adult) (periodic) (physical), gynecological
  • Z23 Vaccination (prophylactic), encounter for

Rationale: The Pap smear is not coded separately. The Index directs the coder to Z01.419 when the Pap smear is part of a routine gynecological exam. Chronic gout is coded as M1A.9 with a seventh character of 1 for with tophus (tophi); add two X placeholders to add the seventh character. Code Z23 is used to code the fact that an immunization was given. A coding note directs the coder that procedure codes are required to identify the types of immunizations given.

Judy Monestime, MBA, CDIP, CPC, is an AHIMA-approved ICD-10-CM/PCS trainer.


Related reading:

Coding tips for respiratory diseases


Multiple coding now required for nervous system diseases


Eye diseases get their own new coding section under ICD-10


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