Mary Jo Bowie MS, BS, AAS, RHIA, RHIT

Factors Influencing Health Status and Contact with Health Services CHAPTER 26 Factors Influencing Health Status and Contact with Health Services

Factors Influencing Health Status and Contact with Health Services—Z00-Z99 Factors influencing health status and contact with health services are reported from Chapter 21 of ICD-10-CM. Codes from this chapter are used to represent reasons for encounters.

Chapter 21 of ICD-10-CM—Codes Z00-Z99 Z codes are used for occasions when circumstances other than disease, injury, or external cause classifiable to categories A00-Y84 are recorded as “diagnosis” or “problems.”

Examples of Z Code Assignment When a person who may or may not be sick encounters the health services for some specific purpose, such as an immunization To discuss a problem that is in itself not a disease or injury, such as lack of housing

Additional Examples When some circumstances or problem is present which influences the person’s health status but is not in itself a current illness or injury, such as tobacco use.

Persons Encountering Health Services for Examinations—Z00-Z13 This block is used to report: General and special examinations without complaint, suspected or report diagnosis Encounters for administrative examinations Examination and observation encounters Follow-up examinations Screenings for diseases

Genetic Carrier and Genetic Susceptibility to Disease—Z14-Z15 This block reports the following categories: Z14—Genetic carrier Z15—Genetic susceptibility to disease

Categories Z16 and Z17 Z16 reports infection with drug-resistant microorganisms. This category is used to indicate the presence of a drug-resistant infectious organism that is classified elsewhere. The code is used as a secondary code with the code of the infection coded first. Z17 reports estrogen receptor status. An instructional notation appears that instructs the coder to code first malignant neoplasm of breast.

Category Z18 Z18 reports retained foreign body fragments The category is differentiated by the type of fragment that is retained in the body.

Persons With Potential Health Hazards Related to Communicable Disease—Z20-Z28 This block reports: Contact with and exposure to communicable diseases Asymptomatic HIV infection status Carrier of infectious disease Encounter for immunization Immunization not carried out

Persons Encountering Health Services in Circumstances Related to Reproduction—Z30-Z39 The encounters reported here are: Z30—Contraceptive management Z31—Procreative management Z32—Pregnancy test and childbirth, and childcare instruction Z33—Pregnant state Z34—Supervision of normal pregnancy

Additional Categories from Z30-Z39 Z36—Antenatal screening of mother Z3A- Weeks of gestation Z37—Outcome of delivery Z38—Liveborn infants according to place of birth and type of delivery Z39—Maternal postpartum care and examination

Encounters for Other Specific Healthcare—Z40-Z53 These categories report encounters for: Z40—Prophylactic surgery Z41—Procedures for purposes other than remedying health state, such as cosmetic appearance, circumcision, piercing Z42- Plastic and reconstructive surgery following medical procedure or healed injury Z43—Attention to artificial openings

Additional Z40-Z53 Categories Z44—Fitting and adjustment of external prosthetic device Z45—Adjustment and management of implanted device Z46—Fitting and adjustment of other devices Z47—Orthopedic aftercare Z48—Other postprocedural aftercare Z49—Care involving renal dialysis

Final Z40-Z53 Categories Z51—Other aftercare, such as radiation, chemotherapy and immunotherapy, and palliative care Z52—Donors of organs and tissues Z53—Health services for specific procedures and treatment not carried out

Persons with Potential Health Hazards Related to Socioeconomic and Psychosocial Circumstances—Z55-Z65 These categories report problems related to: Education and literacy—Z55 Employment and unemployment—Z56 Occupational exposure to risk factors—Z57

Additional Z55-Z65 Categories Housing and economic circumstances—Z59 Social environment—Z60 Upbringing—Z62 Primary support group, including family circumstances—Z63 Psychosocial circumstances—Z64-Z65

Categories Z66-Z68 Z66—Do not resuscitate status: includes DNR Z67—Blood type: specific blood types are differentiated Z68—Body mass index: BMI for adults and pediatric are differentiated

Persons Encountering Health Services in Other Circumstances—Z69-Z76 This block of codes reports encounters for: Mental health services Counseling related to sexual attitude, behavior, and orientation Counseling and medical advice NEC Problems related to lifestyle and life management difficulty, care provider dependency, and medical facilities

Persons With Potential Health Hazards Related to Family and Personal History and Certain Conditions Influencing Health Status—Z77-Z99 This is block of codes reports: Contract with or exposures hazardous to health Long-term drug therapy Family history of diseases Personal history of diseases

Additional Circumstances Reported with Categories Z79-Z99 Allergy status Acquired absence of limb Acquired absence of organs Personal risk factors Personal history of medical treatment Artificial opening, transplanted organ, and tissue status Presence of cardiac, vascular, and other implants, grafts, and devices

Official Guidelines for Coding and Reporting There are numerous guidelines for Chapter 21 of ICD-10-CM that address: Use of Z codes in any healthcare setting Z codes indicate a reason for an encounter Categories of Z codes

Coding Practice Select the code for the following: Screening for respiratory tuberculosis

Coding Practice Solution Main term to reference in index: Screening Modifying term: Tuberculosis, respiratory Code Assignment: Z11.1