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Wiki Z3a Code

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Joanna_runyan

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We just recently received notification that Cigna is stating they will no longer accept claims with the diagnosis code of Z3a.01-Z3a.49. However the ICD-10 book states any chapter O code requires the weeks of gestation. Has anyone else experienced this?
 
I have observed many denials due to some are using the Z3A as first listed code, and sometimes the only code. I would call and clarify if this is what they are referring to as the Z3A codes are to be secondary only.
 
I'll just rehash what michelle said and to get clarification from the payer as its likely just a communication error.

Per ICD-10 CM guidelines

codes in category Z3A, Weeks of gestation, may be assigned to provide additional information about the pregnancy.
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I interpret "additional information" as supplemental meaning, should never be listed on its own or as a primary DX.

Many payers systems care more about the PDX than any other DX on the claim
 
general guidelines

a. General Rules for Obstetric Cases

1) Codes from chapter 15 and sequencing priority

Obstetric cases require codes from chapter 15, codes in the range O00-O9A, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy.

"All of the O codes should be the principal diagnosis as per coding guidelines except Z33.1 if applicable"
Z3A will always be just an additional code and can't be coded alone.
 
For all normal OB, we bill z36 as the primary and z3a as the secondary. As far as I know, we haven't had any issues with the insurance coding this way.
 
I am aware to never code the Z3a code as primary or as the only diagnosis code. Our office only ever bills this as a secondary informational code. I was curious to see if anyone else had received this same communication from Cigna- Thank you for your input- I will call Cigna to verify
 
The Z3A is only required for O codes. I know some do append it with the Z43 and Z36 codes but it not a stated requirement. Perhaps they are referring to claims with only the Z codes fr the supervision?
 
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