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Z76.89 – persons encountering health serviced in other specified circumstances

  1. Default Z76.89 – persons encountering health serviced in other specified circumstances
    Medical Coding Books
    I have a provider using a DX of “Z76.89 – persons encountering health serviced in other specified circumstances” as the primary DX for new patients, he is using the new patient CPT. The provider insists on keeping it as primary, and yes there are subsequent DXs for the same encounter, does anybody else see this DX, and is it being paid?????????

  2. #2
    Is the new patient coming in for a "sick" visit or a for well visits or to establish care? It was seem odd that the provider is using Z76.89 on every new patient.
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

  3. #3
    I have a provider who uses it as well when a patient is coming in to establish care with him. one of the synonyms for this code is case/care management. Seems to me it can be used. I also see now it says med review as a synonym too. I'd also like input on this code.

  4. #4
    According to the ICD-10-CM guidelines, Z codes should only be used as first listed diagnosis if encounter is for circumstances other than disease or injury. Since there is illness or injury documented Z coded cannot be used as primary. Also Other specified means no other code exists. Chances are there is a specific diagnosis could be used even if it ends up being signs/symptoms (R codes)
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

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