Wiki Z codes in risk adjustment

[ndrozof]

In risk adjustment, do Z codes need a provider interpretation of the condition and a plan contained in the A/P? I have attempted to research this and have been unable to find a clear answer. If you have an info or reference source, that would also be helpful.

 

[sls314]

In risk adjustment, do Z codes need a provider interpretation of the condition and a plan contained in the A/P? I have attempted to research this and have been unable to find a clear answer. If you have an info or reference source, that would also be helpful.

Some of it can depend on your project rules. Some of it can depend on the project rules.

For example, typically the Z codes for amputations and ostomies can be picked up if the presence is documented in the exam or review of systems. Unless the rules of your project say otherwise, the physician doesn't have to include them in the plan.

 

[TThivierge]

Hello Ndrof,
Here s the scoop or the tea on using Z dx codes.......
There are first listed Z dx codes and there are lastly dx codes to put on the claim. It depends the scenario the patient is arriving for treatment. Z dx codes are for encounter list and to give the payer more details on the patient s condition. Here is a quick list I know of first listed dx codes Z00-Z03, Z51 related to chemotherapy ,sometimes when vaccines are given use dx Z23, and dx Z38 birth of a baby . Most other Z dx codes can be last on the claim. The ICD10 manuals give you a mark in which Z dx codes can be first listed dx or encounter codes listed in that section in the front.
Now when reading the medical record for the day in which the history documented in these instances you need to add dx code last if supported. If a patient suffers with DM dx E11 and is taking diabetic meds use dx Z79.84 or insulin Z79.4 .Yes use these Z dx codes last on claim. If the provider states pt. had coloscopy last year then discovered polyps you can use dx Z86.010. The Z dx code listed should be related to the current treatment & mentioned or in HO of record. So if provider is treating some one with dx L72 but he mentions in history pt had skin cancer 5 years ago I d use the dx Z85 code. Or if pt has ongoing chronic heart, respiratory, gastro problems add dx Z87.9 past smoker or dx Z72 if a current smoker. The provider mentions it, then code it if linked to what is going on for day s treatment. If the patient is being treated for Obesity or Overweigh dx E66 block and the BMI % is listed in the record add it. BMI % are in dx block Z68 which should be added. If the patient has an amputation dx Z89 or organ transplant Z94 or dialysis due to CHKD stage 5, dx N18.5 add the Z code of Z99.2. Or if the patient has anticoagulants regularly taken due to cardiac condition use dx Z79.89 These need to be listed supported by documented in the treating record of the day. If a female pt. comes in with cold or laceration then they find out she is pregnant right then that day can add dx Z33.1 incidental pregnancy. Or if the 5 month pregnant patient see the dx block is getting treated for skin rash, you can add the dx code last for pregnancy from her trimester dx Z3A too if provider mentions it. There are all kinds of Z dx codes but mostly add last on claim, but depends on current documentation given in record to code.
Well I hope helped you in understanding sequencing Z dx codes.
Lady T