Wiki Medicare Z code primary dx

[nlbarnes]

I received information from a co-worker that you cannot use Z code dx in the primary position for Medicare. I know that there are some that must be listed in the primary position. If this is valid, does it apply to the Z codes that must be listed in the primary position?

 

[sls314]

I received information from a co-worker that you cannot use Z code dx in the primary position for Medicare. I know that there are some that must be listed in the primary position. If this is valid, does it apply to the Z codes that must be listed in the primary position?

There are Z codes can be billed in a primary position to Medicare. For example, the encounter codes for an office visit (Z00.-, etc). Of course, the code you're billing needs to be used correctly.

I code chemo and radiation to Medicare, and frequently use Z51.0 and Z51.1 as my primary diagnosis to Medicare.

 

[jmari002]

i found an article that is helpful on the matter. i'm copy/pasting their answer and including the link below. hope it helps!

"Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis. For example, there are three observation Z code categories for use in very limited circumstances.


Z Codes indicate a reason for an encounter and are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed. For further information, you may refer to ICD-10-CM Official Guidelines for Coding and Reporting, FY 2018 (PDF, 980 KB).


Z Codes That May be Principal/First-Listed Diagnosis
Z codes are a special group of codes provided in ICD-10-CM for the reporting of factors influencing health status and contact with health services. Z codes are designated as the principal/first listed diagnosis in specific situations such as:

• To indicate that a person with a resolving disease, injury or chronic condition is being seen for specific aftercare
• To indicate that a person is seen for the sole purpose of special therapy, such as chemotherapy, immunotherapy and radiation therapy
• To indicate that a person not currently ill is encountering the health service for a specific reason, such as to act as an organ donor, encounter for medical observation for suspected diseases and conditions ruled out, administrative examinations (pre-employment exam, recruitment to armed forces), plastic and reconstructive surgery following medical procedures or healed injury (breast reconstruction following mastectomy)
• To indicate the birth status of newborns"

https://www.palmettogba.com/palmetto/jma.nsf/DIDC/AW9RNX6220~Medicare%20News

 

[smckee40]

I have a denial for 00812 and Allwell is stating that Z86.010 cannot be listed as the primary dignosis. Pt came in for a colonoscopy screening due a history of polyps. Help! Is this correct?

 

[sls314]

I have a denial for 00812 and Allwell is stating that Z86.010 cannot be listed as the primary dignosis. Pt came in for a colonoscopy screening due a history of polyps. Help! Is this correct?

History codes cannot be primary. There should be an encounter code in the first position.

I'm not sure whether Z12.11 would be appropriate to use for a patient with a personal history of polyps. (Z12.11 is Encounter for screening for malignant neoplasm of colon) Gastroenterology is not my area of expertise. If I were working this denial, I'd explore the payer guidelines to find out how surveillance colonoscopies should be billed to them. From the very brief google search I just did, it might be payer dependent.

Since you have the anesthesia claim, can you get additional information to see how the physician submitted the claim? That might help point you in the right direction.

Good luck!

 

[smckee40]

History codes cannot be primary. There should be an encounter code in the first position.

I'm not sure whether Z12.11 would be appropriate to use for a patient with a personal history of polyps. (Z12.11 is Encounter for screening for malignant neoplasm of colon) Gastroenterology is not my area of expertise. If I were working this denial, I'd explore the payer guidelines to find out how surveillance colonoscopies should be billed to them. From the very brief google search I just did, it might be payer dependent.

Since you have the anesthesia claim, can you get additional information to see how the physician submitted the claim? That might help point you in the right direction.

Good luck!

Thank you so much for your advice! I will look into that and see if we can figure it out.

 

[LisaAlonso23]

I have a denial for 00812 and Allwell is stating that Z86.010 cannot be listed as the primary dignosis. Pt came in for a colonoscopy screening due a history of polyps. Help! Is this correct?

Z86.010 cannot be primary. If the patient had a colonoscopy within the past year, Z09 should preceded Z86.010. If the patient had a colonoscopy several years ago, Z12.11, Z86.010 is appropriate. If more polyps were found, Z86.010 would not be reported.