Now’s the time for to us to schedule those mammograms and colonoscopies we may have been putting off, but it is also a good time to take a look our ICD-10-CM Z codes assigned for encounters for screening.
Our encounter for screening Z codes can be found in Chapter 21, Factors Influencing Health Status and Contact with Health Services. Our chapter specific guidelines here instruct us that Z codes are for use in any healthcare setting. While those coders who code outpatient encounters may assign these codes on a more regular basis this is a good reminder for all coders. Another important guidance reminder here is that Z codes are not procedure codes. A procedure code must also be assigned for any screening procedure performed. As the guidelines note, the Z code notes that a screening exam is planned…the assignment of the appropriate procedure code is required to confirm the screening was performed.
Guideline 21.5 specifically relates to Screening. The guideline defines screening as “…the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease.” A screening mammogram is noted as an example here. The phrase “seemingly well” is important here. The next statement in the guidelines instructs us that if the patient is being tested to rule out or to confirm a suspected diagnosis because they are having some specific symptom or sign would not be a screening, but would be a diagnostic examination. Here the specific symptom code would be assigned, not a screening Z code. There is an Excludes 1 note at our screening categories nothing this as well.
Category Z11 identifies encounters for screening for infectious and parasitic diseases. Specific codes identifying HIV, tuberculosis, COVID-19 as well as sexually transmitted diseases would be found here. Category Z12 includes probably the most known screening codes, those for encounters for screening for malignant neoplasms. Here the screening codes identify the specific anatomical site. Z12 also has a Use additional code note instructing the coder to assign an additional code to identify any family history of malignant neoplasm. This would most likely be the reason the patient is requiring the cancer screening examination.
Category Z13 identifies encounter for screening for other diseases and disorders. Included here is our unspecified code option, Z13.9, Encounter for screening, unspecified. Included here at Z13.4 are screenings for certain developmental disorders in childhood including autism and global developmental delays. We also have an Excludes 2 note here noting encounter for routine child health examination (Z00.12-). Remember our excludes 2 notes mean “Not included here,” so these screening codes may be assigned with the routine examination code if appropriate.
Finally, Z36 includes encounter for antenatal screening of mother. Excludes 1 and Excludes 2 notes here help the coder assign the appropriate codes for the encounter. The Excludes 2 note includes routine prenatal care and genetic counseling and testing, again noting these screening codes may be assigned with them if appropriate.
If you routinely assign for screening examinations, take this last week of February to refresh yourself and your coding team on these codes and guidelines. Also take this week to schedule any health screening exams you may need to take care of your health!
Today is Mardi Gras, which is French for “Fat Tuesday.” It is the last day before lent starts tomorrow, Ash Wednesday. This got me thinking
EDITOR’S NOTE: The narrative in this article reflects the firsthand perspectives and professional experience of Tami McMasters Gomez, curated and prepared for publication by Penny
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