Z71.1 versus Z03.89
Hello,
Is there any reference material that someone can share as to when will it be appropriate to assign Z71.1 (Worried well) versus Z03.89 (Encounter for observation for other suspected diseases and conditions ruled out)?
Is Z03.89 specific to observation services only? I would like to see how others use these codes.
Any insight would be greatly appreciated. Have a great day!
Hi,
I don't have a straightforward reference on when to use each code but have some information that may help. Looking at the ICD-10-CM guidelines, you will see that Z71.1 is a counseling code. Counseling codes are reported for assistance or support in coping with illness, family, or social problems. Worried well fits here because many physicians spend a good deal of time with patients who have concerns (often out of proportion to physical findings) regarding their health and symptoms but no diagnosed illness. Z71.1 may be reported in addition to codes for related symptoms or other codes describing patient concerns.
Z03 on the other hand is an observation code (not meaning hospital observation, see Coding Clinic guidance for ICD-9 codes for observation below). Observation of a patient for a suspected condition that is ruled out is reported when the patient has no signs or symptoms of illness but there is reason to suspect a condition (e.g., parent suspects child is constipated because no bowel movement for three days [Pediatricians have said that children are never "worried well" so code Z71.1 does not typically apply in pediatric care]). Observation Z codes are always the principal or first-listed diagnosis and additional codes are reported only if they are unrelated to the suspected condition being observed (e.g., parent is concerned patient has pink eye where there are no findings suggestive of pink eye but physician notes a mild strabismus and refers to ophthalmologist).
AHA Coding Clinic, 2002 Vol.19 No.1
Question: A five-week -old infant is brought into the emergency department by the parents because of persistent crying. The parents were anxious, because they thought something was wrong with the baby. Upon examination by the physician, no problem could be found. The physician recorded "parental anxiety" as the discharge diagnosis. How should this encounter be coded? Answer: Assign code V71.9, Observation for unspecified suspected condition, for this encounter. When the infant is less than 29 days, assign code V29.9, Observation for unspecified suspected condition, instead.
I always found this confusing in ICD-9 and it's no easier in ICD-10-CM but I hope this helps.
Cindy
