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

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

3. 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.

4. 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.”

5. 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

6. 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.

7. 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

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

9. 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.

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

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

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