• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Can't be principle DX

I

isapra

New
Messages
2
Location
Morristown, NJ
We are getting Cigna Denial for LARC and DPMA stating that Z30.430,z30.017, z03.013, z30.42 can't principal diagnosis. Anyone has suggestion as to what diagnosis should be used as principal diagnosis in this case?
 
We are receiving the same denials from Cigna stating that Z30.430 can't be a principal diagnosis code. This is something that has just started. I did see in the guidelines it states that Z30.430 can not be the primary diagnosis. However the guidelines do not give good instruction on what to code first for contraceptive/family planning, that is acceptable as a primary diagnosis code. Most of the family planning contraceptive codes are all Z codes, which most of the Z codes for contraceptive counseling codes are all marked as non-primary diagnosis codes, except Z30.2. Would it be appropriate to code sterilization Z30.2 first and then the Z30.014 for initial prescription of IUD and then Z30.430 for IUD insertion? Currently we only utilize the Z30.2 sterilization for surgical sterilization? Is birth control considered sterilization, even though it is temporary and not permanent? Any suggestions on what should be coded as the primary diagnosis code for contraceptive encounters?
 
Hello
Unless the Z code is a first listed diagnosis insurance companies will not process for payment. You must give a reason for the female patient s medical problem. Such as dx N75.0 Cyst on V muscle, or N82.1 Didelphys (double vagina) N94.6 Dysmenorrhea or dx N85.5 Inverted Uterus which would be documented and put on as first dx. on the claim. Z codes should come last as more info for the payer.

I use to be a reimbursement manager and auditor for a payer years ago.

I hope this information helps you.

Lady T
 
I agree with the above. If the Z code does not have a 'must be listed as primary diagnosis' error, then the Z codes should typically come last on the claim. Insurance companies would rather have this, because the Z codes are more of extra information codes usually.
 
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
 
lisa30052@gmail.com said:
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
Click to expand...
If a patient is being actively being treated for a condition, it's not appropriate to assign a history code. Sadly, many providers document a "history of" a condition that the patient is actively being treated for.
 
lisa30052@gmail.com said:
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
Click to expand...

I think a screening code would be more appropriate, with history of the condition as the 2ndary DX.
 
Hi Isapora🚼
First thing is yes only certain Z dx codes can be billed first(usually dx block of Z01 and Z51 for chemotherapy). The payer wants to know why the patient is assigned the LARC of IUD or implant or DPMA meds. Is because she has blood disorder and IUD will cause further problem for her? See dx D68.61,072, 045, 046, 067...has your provider mentioned any of these problems? . Is the patient given a IUD because she had high risk birth or abortion or cardiac or uterine problems or defective newborn in the past? See dx codes 000 to 007, 07, 075 072.3, N96 ,N85, O34,045 046 or 067 or some kind of chronic problem as dx N99 or N25 as possible reasons pt suffers (principal dx codes) and gets meds as of DPMA . Also if patient has a history of some disease and still getting medications it may mean still being treated. However if truly past condition is healed provider should put estimated date or year so aware it is truly in the past to add Z86 dx block. Also you can look up any CPT code to get list of matching dx codes in the CMS physician fee . This data may help you too.
I hope helped you a little bit
Lady T:)
 
lisa30052@gmail.com said:
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
Click to expand...
Hi Lisa
This can be hard to get but if pt. still have problem, get meds or need refill and coming back for check up I d put dx code then Z09 or Z08 as 2nd dx follow up on condition. Also ask provider give better dx description or notations. So if Prostate problem use dx N42 or N42.89 as primary dx then dx Z09. If pt Prostate Cancer back or less than 5 years ago add dx C61 and then Z08 dx as 2nd. If pt had urinary tract problem of dx R39 then add symptoms returning I d put N28.89 and Z09 or Z13.89 as 2nd dx. or add history of Prostate CA.Z85 last. Also as 2nd dx can use Z76 if get new meds, or if provider checking med use dx Z51.81 as 2nd dx. I had urology visit dx called Recurrent Castration with dx C61 Prostate CA as assessment. Never seen that before but from notations I coded it dx C61 and dx Z19.2 .

As example we get COVD pt coming for lab test...I put J98.8 as first dx then Z11.52 as 2nd dx to bill for test if negative results. If positive COVID results use dx U01 and dx Z11.52 then. COVID is type of respiratory ds thus so bill first the dx J98.8 respiratory illness or if R05 cough or congestion dx R09.81 per provider assessment or reason why want COVID test.
I hope I explained this a bit better
Lady T
 
Last edited:
I read the article " Z Codes: Who’s on the First?" can DX Z71.83 Encounter for nonprocreative genetic counseling be used as principle DX? If patient is coming into Genetic High Rick Breast clinic, with Z84.81 & Z80.3 will payers accept the Z71.83 as primary DX code?
 
Hi DRSZ
No the payers will not take dx Z71 as first dx on claim. It will probably get denied .Why not using a definitive dx codes or R code of symptoms elated to high risk breast problems? do any of dx N60-N65 dx blocks can be used as first dx, check out dx N94, N97 if match pt s problems, or dx R92 or Z01.89? Id use the Z01.89 as first since it is first listed dx code whereas the other Z codes are not since seems not given medical necessity reason. Alos go back to provider for more info
Well hope data helped you somewhat
Lady T :)
 
lisa30052@gmail.com said:
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
Click to expand...
I work in Urology too, we discussed this issue at one of our coding meetings. We use Z08 or Z09 depending on what the patient is seen for. Z08 w/ Z85.46 or Z09 w/ z87.442, Z87.440 etc. I haven't heard of any denials since doing this. If there is no hx code then we code z09 and whichever N or R code that pertains to the documentation.
 
You must log in or register to reply here.
Top