Wiki Z code sequencing


Tampa, FL
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in the use of z codes, I do understand there are some that are first position, and it certainly depends on the documentation. in ICD-9, V codes, unless in first position, went after regular codes, and before E codes, in my experience and understanding. So, I am trying to find a definitive answer, for sequencing of the z codes that are NOT in first position. Z codes such as trach status, vent dependent, etc... I'll make up a simple but real example:

Dr. Dx list. (note this is inpatient professional and the RFV was the respiratory failure

1. Acute Respiratory failure with hypoxia
2. status tracheostomy
3. Gastritis

Would this be sequenced as: J96.01, Z93.0, K29.70....OR....J96.01, K29.70, Z93.0
Since Z codes are the V code replacement I think they should go last in this example. Here is what the ICD-10 guidelines say about the Z status codes:

2016 ICD-1-CM Guideline I.C.21.c.3 said:

Status codes indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition. This includes such things as the presence of prosthetic or mechanical devices resulting from past treatment. A status code is informative, because the status may affect the course of treatment and its outcome. A status code is distinct from a history code. The history code indicates that the patient no longer has the condition.

A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code. For example, code Z94.1, Heart transplant status, should not be used with a code from subcategory T86.2, Complications of heart transplant. The status code does not provide additional information. The complication code indicates that the patient is a heart transplant patient.

For encounters for weaning from a mechanical ventilator, assign a code from subcategory J96.1, Chronic respiratory failure, followed by code Z99.11, Dependence on respirator [ventilator] status.