hey guys believe it or not we actually only have a couple more chapters in the chapter specific guidelines to cover we have external causes of morbidity we have factors influencing health status in contact with health services and then our codes for special purposes [Music] hey everyone i'm victoria i'm a medical coder auditor educator and content creator and on my channel i provide tips tricks and tutorials to help you be successful in a medical coding career i'm working on the series on the icd-10-cm coding guidelines we are just finishing up with the last few chapters of the chapter specific guidelines let's get to it all right so chapter 20 is the external causes of morbidity categories v00 through y99 and these should never be a first listed or principal diagnosis so never ever ever first on the claim they should always be secondary to something else there's something that in most cases you can kind of push to the bottom of the list use of the external cause codes is not mandatory it is used to provide additional data so injury research and for prevention strategies on why those injuries occurred the codes capture how the injury occurred what was the cause the intent so was it an intentional unintentional was it a suicide attempt was it an assault where it occurred so did it occur in the soccer field did it occur in a penitentiary and what was the patient's status so were they civilian or military there is no national mandate in order to use these codes however there may be some pair requirements for that for example if a patient comes in and broke their arm and that goes to their medical insurance their medical insurance might kick it back and say hey was this related to a workers comp or an mva because in that case it should go through either the workers compensation or the motor vehicle insurance to cover that accident or injury so again they are not um mandated there may be some state-based external cause reporting requirements or payer requirements but they are generally encouraged because of that additional data it does provide that we can use then for things like research and prevention strategies general external cause coding guidelines so an external cause code may be used with any code in the range of a 0 0 0.0 through t 88.9 or z00 through z99 the classification that represents a health condition due to an external cause though they are most applicable to injuries they are also valid for use with things such as infections or diseases due to an external source and other health conditions such as a heart attack that occurs during a strenuous physical activity like maybe the patient is shoveling snow and they have a heart attack that's one that they say to be very careful of that that happens in our elderly population so in that case we would want to designate that snow shoveling was that cause something that was a component of what triggered that heart attack external cause code used for length of treatment assign the external cause code with the appropriate seventh character so was it initial was it subsequent or was it a sequela for each encounter which the injury or condition is being treated most categories in chapter 20 have a seventh character requirement so you're going to see a lot of those x placeholders in these codes so the a is the initial encounter d is for the subsequent encounter and then s is the sequel and we already talked about those so a is for the active treatment d for the healing phase and s for those residual effects the sequela while the patient may be seen by a new or different provider over the course of the treatment injury etc etc etc the assignment of the seventh character should match the seventh character code assignment not just necessarily initial like it's that first time the provider is seeing it use the full range of external cause code so use as many as you need to describe the cause the intent the place of it service place of occurrence rather and if applicable the activity of the patient at the time of the event and the patient's status for all injuries and other health conditions due to an external cause assign as many external cause codes as needed so as many as you can record assign as many as you can that are related to that principle diagnosis selection of the appropriate external cause code so the selection of the appropriate external cause code is guided by the alphabetic index of external causes and by inclusion and exclusions notes in the tabular listing external cause codes can never be a principle or first listed diagnosis some of the external cause codes are combination codes and they identify sequential events that result in an injury such as a fall that results in striking against an object the injury may be due to either event or both the combination external cause code should correspond to the sequence of events regardless of which caused the most injury there are certain circumstances where you really don't need an external cause code so no external cause code from chapter 20 is needed if the external cause and intent are included in a code from another chapter so for example t36.0x1 is poisoning by penicillins accidental unintentional so that case we wouldn't need an external cause code if there was none that was applicable place of occurrence guideline so codes from category y92 place of occurrence of the external cause are secondary codes for use after the other external cause codes to identify the location of the patient at the time of the injury so if we go back to our example about the snow shoveling patient we would have this activity of snow shoveling first and then we would have the place of occurrence of maybe you know outside the patient's residential home generally the place of occurrence is only ever needed once at the initial encounter for the treatment however there are rare instances that a new injury occurs during hospitalization in that case an additional place of occurrence code may be assigned there are actually no seventh character extensions used for this category for y92 do not use place of occurrence y92.9 if the place is not stated or is not applicable activity code so assign a code from category y93 activity code to describe the activity of the patient at the time of the injury or other health condition occurred an activity code is only used once at the initial encounter for the treatment only one code from y93 should be recorded on a medical record the activity codes are not applicable to poisonings adverse effects misadventures or sequelae and do not assign y9 3.9 unspecified activity if activity is not stated a code from category y93 is appropriate for use with external cause codes and intent codes if identifying the activity provides additional information about the event place of occurrence activity and status codes used with other external cause codes so when applicable place of occurrence activity and external cause status codes are see are sequenced after the main external cause codes regardless of the number of external cause codes assigned generally there should be only one place of occurrence code one activity code and one external cause status code assigned to an encounter however in the rare instance that a new injury occurs during hospitalization an additional place of occurrence code may be assigned if the reporting format limits the number of external cause codes so if the reporting format limits the number of external cause codes that can be used in reporting clinical data report the code for the cause or intent most related to the principal diagnosis if the format permits capture of additional external cause codes the calls and intent including medical misadventures of the additional events should be reported rather than the codes for place activity or external status multiple external cause coding guidelines so more than one external cause code is required to fully describe the external cause of an illness or injury the assignment of external cause codes should be sequenced in the following priority if two or more events cause separate injuries an external cause code should be assigned for each cause the first listed external cause code will be selected in the following order external cause codes for child and adult abuse take priority over all other external cause codes external cause codes for terrorism events take priority over all external cause except child and adult abuse next would be cataclysmic events they would take a priority over all except for child and adult abuse and terrorism and then next in sequencing would be external cause for transport accidents they take priority except for the cataclysmic events child and adult abuse or terrorism and activity and external cause status codes are assigned following all causal or intent external cause codes the first listed external cause code should correspond to the harm of the most serious diagnosis due to the assault accident or self-harm following the order of hierarchy listed above any adult or child abuse neglect and maltreatment are classified as assault any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse for confirmed cases of abuse neglect or maltreatment when the perpetrator is known a code from y07 perpetrator of maltreatment and neglect should accompany any other assault codes unknown or undetermined intent guideline if the intent which is accident self-harm or assault of the cause of the injury or other cause is unknown or unspecified code the intent as accidental intent all transport accident categories assume accidental intent most people don't intend to get into a transport accident use of undetermined intent external cause codes for events of undetermined intent are only for use if the documentation in the record specifies that the intent cannot be determined late effects of external cause guidelines so sequela of external cause code sequela are reported using the external cause codes with the seventh character s for sequela these codes should be used with any report of a late effect or sequela resulting from a previous injury sequela external cause codes with a related current injury a sequela external cause code should never be used with a related current nature of injury code use of sequela external cause codes for subsequent visits so use of a late effect external cause code for subsequent visits when a late effect of the initial injury is being treated do not use a late effect external cause code for subsequent visits for follow-up care so to assess healing for subsequent rehab therapy and don't assign it when there is no late effect of the injury documented so terrorism guidelines the cause of injury identified by the fbi as terrorism when the cause of an injury is identified by the fbi as terrorism the first listed external cause code should be a code from category y38 which is terrorism the definition of terrorism employed by the fbi is found on the inclusion note at the beginning of category y38 use additional code for place of occurrence so those are our y92 codes and then more than one y-38 code may be assigned if the injury is the result of more than one mechanism of terrorism and let's take a look at some of these codes that we have in this category so we have here terrorism involving fires conflagration and hot substances involving firearms public safety officials injured civilian injured terrorist injured we also have nuclear weapons biological weapons chemical weapons over here we have involved other unspecified means and then terrorism secondary effects when the cause of an injury is suspected to be the result of terrorism a code from category y38 should not be assigned suspected cases should be classified as an assault so it has to specify that it was confirmed terrorism not a suspected case code y38.9 which we just looked at terrorism secondary effects what does that mean so we assign y38.9 terrorism secondary effects for conditions occurring subsequent to the terrorist event this code should not be assigned for conditions that are due to the initial terrorist act it is acceptable to assign code y38.9 with another code from y-3-8 if there is an injury due to the initial terrorist event and an injury that is subsequent result of the terrorist event external cause status so a code from category 199 which is the external cost status should be assigned whenever any other external cause code is assigned for an encounter including an activity code except for when noted as follows we assign a code from category y99 external cost status to indicate the work status of the person at the time the event occurred so the status code indicates whether the event occurred during military activity whether a non-military person was at work whether an individual including a student or volunteer was involved in a non-work related activity at the time of the causal event a code from category y99 external cost status should be assigned when applicable with other external cause codes such as transport accidents and falls the external cause status codes are not applicable to poisonings adverse effects misadventures or late effects do not assign a code from category y99 if no other external cause codes cause or activity are applicable for the encounter an external cost status code is used only once at the initial encounter for treatment and only one code from y99 should be recorded on a medical record do not assume in category y99 unspecified external cost status if the status is not stated chapter 21 is our factors influencing health status and contact with health services category zero zero through z 99 so these are a lot of things like our preventative medicine like they're coming in for a well visit our social determinants of health are in this category so use of any z codes in any healthcare setting z codes are for use in any healthcare setting z codes may be used as either a first listed principle diagnosis in the inpatient setting or as a secondary code depending on the circumstances of the encounter certain z codes may only be used as a first listed or principal diagnosis z codes indicate a reason for the encounter so z codes aren't procedure codes a corresponding procedure code must accompany a z code to describe any procedure performed so categories of z codes contact or exposure so category z20 indicates contact with and suspected exposure to communicable diseases these codes are used for patients who are suspected to have been exposed to a disease by close personal contact with an infected individual or in an area where a disease is epidemic category z77 other contact with and suspected exposure is hazardous to health indicates contact with and suspected exposures hazardous to health contact or exposure codes may be used as a first listed code to explain an encounter for testing or more commonly as a secondary code to identify a potential risk inoculations and vaccinations so code z23 is used for any sort of inoculation or vaccination which is really nice because back in i-9 we had dozens of different codes for every different type of vaccination now there's just a general code z23 it makes life a lot easier it indicates that a patient is being seen to receive a prophylactic inoculation against a disease procedure codes are required to identify the actual administration of the injection and the type of immunization that was given code z23 may be used as a secondary code if the inoculation is given as a routine part of a preventative health care such as a well-baby visit status codes so status codes indicate that a patient is either a carrier of a disease or has the sequela or residual of the past disease or condition this includes such things as the presence of a prosthetic device or a mechanical device resulting from past treatment like maybe a pacemaker or a knee replacement and a status code is informative because the status may affect the course of treatment and its outcome a status code is distinct from a history code the history code indicates that the patient no longer has the condition a status code should not be used with a diagnosis code from one of the body system chapters if the diagnosis code includes the information provided by the status code so for example code z94.1 is heart transplant status and that should not be used with code from subcategory t8 6.2 complications of the heart the status code does not provide additional information the complication code indicates that the patient is a heart transplant patient for encounters for weaning from a mechanical ventilator assign a code from subcategory j96.1 chronic respiratory failure followed by z99.11 dependent on a respirator status the status codes are z14 is genetic carrier so genetic carrier status indicates that a person carries a gene associated with a particular disease which may be passed to offspring such as hemophilia z15 is genetic susceptibility to disease so that means that the person is has an increased risk of developing that disease because of their genes codes from category z15 should not be used as the principle or first listed diagnosis if the patient has a condition to which he or she she is susceptible and that condition is the reason for the encounter then we should code the reason that current reason for the encounter first and if the patient is being seen for follow-up after completed treatment of this condition and the condition no longer exists a follow-up code should be sequenced first followed by the appropriate personal history and genetic susceptibility codes if the purpose of the encounter is genetic counseling associated with procreative management code z3 1.5 encounter for genetic counseling should be assigned as the first listed code followed by a code from category z15 actually let's take a look at what is included in that z15 category so if we look at these these are a lot of them are cancer things so genetic susceptibility to malignant neoplasms of the breast the ovary prostate endometrium and then the others are just genetic susceptibility to other diseases so multiple endocrine neoplasia and then just two other disease z16 is resistance to antimicrobial drugs so this code indicates that a patient has a condition that is resistant to antimicrobial drug treatment and we sequence the infection code first z17 is estrogen receptor status z18 retained foreign body fragments z19 hormone sensitivity malignancy status z21 is asymptomatic hiv infection status and that's the code to identify that a patient is tested positive for hiv but they haven't actually shown any signs or symptoms of the disease z22 is a carrier of an infectious disease that means the patient is a character carrier of any sort of specific organism of a disease without manifest symptoms and is capable of transmitting the infection z28.3 is under immunization status z 33.1 is pregnancy state incidental and that's only used as a secondary code when the patient is being seen for something other than pregnancy but oh yeah incidentally they're pregnant uh z 66 is for dnr so that's when the patient has decided that they are on do not resuscitate status anytime during this day z six eight is blood type z six eight is your bmi your body mass index that can play a part in risk adjustment because there are certain bmis that do risk adjust when the patient has a morbidly obese bmi z74.01 is bed confinement status z76.82 is awaiting organ transplant status and then z78 is other specified health status code z78.1 physical restraint status may be used when a patient is documented by the provider that the patient has been put on restraints so maybe they've tied them to the bed or put some sort of restraint on them so that they won't attack anyone or themselves or pull out their catheter and that's during that current treatment or current encounter please note this code should not be reported when it is documented by the provider that a patient is temporarily restrained during a procedure z79 is long-term current drug therapy and codes from this category indicate a patient's continuous use of a prescribed drug including things like aspirin therapy for the long-term treatment of a condition or for prophylactic use it is not used for patients who have an addiction to drugs this subcategory is not used for the medications for detoxification or maintenance programs to prevent withdrawal symptoms such as methadone assign the appropriate code for the drug use abuse or dependence instead assign a code from z79 if the patient is receiving a medication for an extended period as a prophylactic measure such as for the prevention of deep vein thrombosis or as a treatment of a chronic condition such as arthritis or a disease requiring a lengthy course of treatment such as cancer do not assign a code from category z79 for medication being administered for a brief period of time to treat an acute illness or injury such as a course of antibiotics to treat bronchitis z88 is allergy status to drugs medicaments and biological substances except for z 88.9 which is allergy status to unspecified drugs medicaments and biological substance status z89 is acquired absence of a limb z90 is acquired absence of organ not elsewhere classified z910 allergy status other than two drugs and biological substances z92.82 is status post administration of rtpa or tpa in a different facility within the last 24 hours prior to admission to a current facility so we assigned z79.82 status post administration of tpa to a different facility within the last 24 hours prior to admission to current facility as a secondary diagnosis when a patient is received by a transfer into a facility and documentation indicates they were administered tissue plasmogen activator within the last 24 hours prior to admission to the current facility the guideline applies even if the patient is still receiving the tpa at the time they are received into the current facility the appropriate code for the condition for which the tpa was administered should be assigned first code z92.82 is only applicable to receiving the facility record and not to the transferring facility record z93 is artificial opening status z94 is transplanted organ or tissue status z95 is presence of cardiac and vascular implants and grafts c96's presence of functional implants z97 presence of other devices z98 other post-procedural states so assign z98.85 for transplanted organ removal status to indicate that a transplanted organ has been previously removed this code should not be assigned for the encounter in which the transplanted organ is removed the complication necessitating removal of the transplanted organ should be assigned for that encounter z99 dependence on enabling machines and devices not elsewhere classified of note category z89 through z90 and z93 through z99 are for use only if there are no complications or malfunctions of the organ or tissue replaced the amputation site or the equipment used in that case you want to start looking under those complication codes like a mechanical failure type of code history of so there are two types of history codes your personal history and your family history personal codes are the ones that the patient has personally had but they no longer currently are receiving treatment for them they don't currently exist but they may potentially recur so there's an important part of their medical record as far as reporting that they have a history of it so family history are codes that the patient who has a blood relative not their uncle by marriage not a step parent or someone who's not blood related to them you know that they are at risk for a particular disease because they're someone who has a blood relationship to them that has that disease as well personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or a procedure history codes are also acceptable on any medical record regardless of the reason for the visit a history of an illness even if no longer present is an important information that may alter the type of treatment ordered so these are all the history z codes i'm not going to read through all of them for you screening so screening is the testing for disease or disease precursors and seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease so if you have a screening mammography that might indicate that you have some sort of abnormality that they want to look at in case it is a you know a tumor or some sort of cancer the testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination not a screening in these cases the sign or symptom is used to explain the reason for the visit so screening is you don't have any symptoms we're just checking you out maybe like a routine screening colonoscopy but when it's diagnostic you're having some kind of sign or symptom so let's go back to this my mammography if you're just a a patient who's coming in for your annual mammography because you've turned 40 and it's time for you to get your mammography that would be screening if you go to your provider and you say hey i have a lump in my breast and i think you know i want this checked out that would be a diagnostic mammography a screening code may be a first listed code if the reason for the visit is specifically the screening examination it may also be used as an additional code if the screening is done during an office visit for other health problems a screening code is not necessary if the screening is inherent to a routine examination such as a pap smear done during a routine pelvic examination should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis z code indicates that a screening exam is planned a procedure code is required to confirm that the screening was performed so here are some examples z11 encounter for screening for infection parasitic diseases c12 malignant neoplasms z13 other diseases and disorders z36 antenatal screening for mother observation there are three observation z category codes and they are used in very limited circumstances when a person is being observed for a suspected condition that is ruled out the observation codes are not used if an injury or illness or any signs or symptoms related to the suspected condition are definitively present in such cases the diagnosis or symptom code is used with the corresponding external cause code the observation codes are primarily to be used as a principle or first listed diagnosis an observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principle or first related condition so for example patient presents for treatment following injuries sustained in mva and they're also observed for suspected coven infection and that's subsequently ruled out also when the principal diagnosis is required to be a code from category z 38 which is live born infants according to the place of birth and type of delivery then a code from category 05 encounter for observation and evaluation of a newborn for suspected diseases and conditions ruled out is sequenced after the z38 code additional codes may be used in addition to the observation code but only if they are unrelated to the suspected condition being observed codes from subcategory 03.7 encounter for suspected maternal and fetal conditions ruled out may either be used as a first listed or an additional diagnosis code depending on the case they are for use in very limited circumstances on a maternal record when an encounter is for a suspected maternal or fetal condition that is ruled out during the encounter so for example a maternal or fetal condition may be suspected due to an abnormal test result these codes should not be used when the condition is confirmed in those cases the confirmed condition should be used in addition these codes are not for use of an illness or signs or symptoms related to the suspected conditions or problem or present in such cases the diagnosis or symptom is coded additional codes may be used in addition to the code from subcategory 03.7 but only if they are unrelated to the suspected condition being evaluated codes from subcategory 03.7 may not be used for encounters for antenatal screening of the mother for encounters for suspected fetal condition that are inconclusive following testing or evaluation assign the appropriate code from categories 0.35 36 40 or 41. the observation code categories are 03 encounter for medical exam the observation z code categories are 03 counter for medical observation for suspected diseases and conditions ruled out and then zo4 is for observation for other reasons zo5 is for observation of newborn for suspected diseases and conditions ruled out aftercare so aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase or for long-term consequences of that disease the aftercare z codes should not be used if treatment is directed at a current acute disease the diagnosis code is to be used in these cases exceptions to this rule are code z51.0 encounter for anti-neoplastic radiation therapy encodes from subcategory z5 1.1 encounter for anti-neoplastic chemotherapy and immunotherapy these codes are to be listed first followed by the diagnosis code when a patient's encounter is solely to receive radiation therapy chemotherapy or immunotherapy for the treatment of a neoplasm if the reason for the encounter is more than one type of anti-neoplastic therapy code z51.0 and the code from subcategory z5 1.1 may be assigned together in which case one of those codes would be reported as a secondary diagnosis the aftercare z codes should also not be used for aftercare for injuries for after care of an injury assign the acute injury code with the appropriate seventh character so most cases that would be either the d for the subsequent encounter or the s for the sequela the after care codes are generally listed first to explain the specific reason for the encounter an aftercare code may be used as an additional code when some type of aftercare is provided in addition to the reason for admission and no diagnosis code is applicable an example of this would be the closure of a colostomy during an encounter for a treatment of another condition after care codes should be used in conjunction with other aftercare codes or diagnosis codes to provide better detail on the specifics of an aftercare encounter visit unless otherwise directed by the classification the sequencing of multiple aftercare codes really depends on the circumstances of that encounter certain aftercare z code categories need a secondary diagnosis code to describe the resolving condition or sequela for others the condition is included in the code title additional z aftercare codes include fitting an adjustment or attention to artificial openings status c codes may be used with aftercare z codes to indicate the nature of the aftacare so for example z95.1 is presence of um aortic coronary bypass graft and that may be used with z4 8.812 encounter for surgical aftercare following surgery on the circulatory system to indicate the surgery for which the aftercare is being performed a status code should not be used when the aftercare code indicates the type of status such as z43.0 encounter for attention of tracheostomy with z393.0 tracheostomy status the aftercare z category codes we have for two which is for after care of plastic and reconstructive surgery following medical procedure or healed injury four three is artificial openings four four is fitting an adjustment of external prosthetic devices four five is for management of implanted devices four six encounter for fitting and adjustment of other devices four seven is orthopedic care for eight encounter for other post procedural after care for nine is for care involving renal dialysis and 5-1 encounter for other aftercare and medical care follow-up so the follow-up codes are used to explain continuing surveillance following completed treatment of a disease condition or injury they imply that the condition has been fully treated and no longer exists they should not be confused with aftercare codes or injury codes with a seventh character for subsequent encounter that explain ongoing care of a healing condition or its sequela follow codes may be used in conjunction with history codes to provide the full picture of the healed condition and its treatment the follow-up code is sequenced first followed by the history code the follow-up z-code category 08 is for completed treatment of malignant neoplasm zo9 is for completed treatment of conditions other than malignant neoplasm and three nine is for encounter for maternal postpartum care and examination donor so codes in category z52 are for donors of organs and tissues and are used for living donors who are donating blood or other body tissue these codes are used only for individuals donating for others not for self donations and they are not used to identify cadaver donations 10 is counseling counseling z codes are used when a patient or family member receives assistance in the aftermath of an illness or injury or when support is required in coping with family or social problems counseling z codes i won't read those to you here because it's kind of a long list encounters for obstetrical and reproductive services so z codes for pregnancy care are used in these circumstances when none of the problems or complications included in the codes from the obstetric chapter exist codes in categories z34 are encountered for supervision of normal pregnancy and they are always first listed and are not to be used with any other codes from the ob chapter that would indicate that there would be like a complication because then it would be a normal pregnancy codes in category z3a weeks of gestation may be assigned to provide additional information about the pregnancy category z3a codes should not be assigned for pregnancies with a board of outcomes elective termination of pregnancy nor for postpartum conditions as category z3a is not applicable for those conditions the date of the admission should be used to determine the weeks of gestation for inpatient admissions that encompass more than one gestational week the outcome of delivery which is category z3 z37 should be included on all maternal delivery records it is always a secondary code codes in category z37 should never be used on the newborn record they go on the mom record z codes for family planning or procreative management and counseling should be included on an obstetric record either during the pregnancy or postpartum stage if applicable and then here's the z codes mostly for the z 30 sections that involve child care and procreative management etc newborns and infants z76.1 is encountered for health supervision and care of a foundling z00.1 those are encountered for routine uh child health examinations and z38 live born infants according to the place of birth and type of delivery for the additional characters there routine and administrative examinations so the z codes allow for the description of encounters for routine examinations such as general checkup or for examinations for administrative purposes purposes such as a pre-employment physical these codes are not to be used if the examination is for a diagnosis of a suspected condition or for treatment purposes in those codes we in those categories we would cases rather we would use the um diagnosis codes the the definitive diagnosis that we are looking at or sign or symptom or whatever it might be during a routine exam should a diagnosis or condition be discovered it should be coded as an additional code pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition some of the codes for routine health examinations distinguish between with and without abnormal findings code assignment depends on the information that is known at the time of the encounter that's being coded so for example if no abnormal findings were found during the examination but the encounter is being coded before the test results are backed it is acceptable to assign that without normal findings when assigning the code for with abnormal findings there should be some sort of additional code to identify what what was that a normal finding was it maybe a breast lump or or something like that preoperative examination and pre-procedural laboratory examination z codes are only used in the situations when a patient is being cleared for a procedure or surgery and no treatment is given the z codes categories for routine administrative examinations so we have z zero zero sometimes people will refer to this as the zoo diagnosis and that's for um general examination without complaint suspected or reported diagnosis zo1 is for other special examinations co2 is for administrative examinations and then z3 2.0 is encountered for pregnancy test miscellaneous z codes so the miscellaneous z codes capture a number of other healthcare encounters that do not fall into one of the other categories certain of these codes identify the reason for the encounter others are for use as additional codes that provide useful information on circumstances that may affect the patient's care and treatment prophylactic organ removal so for encounters specifically for prophylactic removal of an organ so for example if a patient has a very high risk of developing breast cancer and they've decided that because of that they would rather have their breasts removed in advance in case they would develop breast cancer that would be the first listed or principal diagnosis so for example z40 is encountered for prophylactic surgery followed by the appropriate codes to identify the risk factors such as maybe the family history or genetic susceptibility if the patient has a malignancy on one site and is having a prophylactic removal on the other side either to prevent it or is maybe part of a metastatic disease a code for the malignancy should also be assigned in addition to a code from subcategory z4 0.0 encounter for prophylactic surgery for risk factors related to malignant neoplasms a z40.0 code should not be assigned if the patient is having organ removal from a treatment of malignancy such as the removal of the testes for treatment of prostate cancer and then there's more miscellaneous z codes and categories again i'm not going to read through the whole whole listing for you guys non-specific z codes certain z codes are so non-specific or potentially redundant with other codes in the classification that there can be little justification for their use in the inpatient setting their use in the outpatient setting should be limited to those instances when there is no further documentation to present permit more precise coding otherwise any sign or symptom should be used that's captured in another code some of the non-specific z code category 02.9 encounter for administrative exams unspecified then we have unspecified reason encounter for screening unspecified personal history of other mental health and behavioral disorders et cetera et cetera et cetera c codes that may only be the principal or first listed diagnoses so the following z codes in these categories that they're listing here may only be reported as the principle or first listed diagnosis except when there are multiples of these types of codes so let's take a look here we have z000 those may only be reported as the first list of diagnosis zl1 zo2 z04 z3 throughput 2 etc etc etc so these have to be listed as the first listed diagnosis or our principal diagnosis and then we have chapter 22 which is a new chapter for 2021 codes for special purposes there's only really two codes that are in there right now u07.0 which is vaping related disorder and then u07.1 which is for the code for covid19 so that's it that is all of the chapter specific guidelines i will still cover section two which is the selection of the principal diagnosis and then we have section three reporting additional diagnoses in section four diagnostic coding and reporting guidelines for outpatient services and then that's it that's the whole series and then in 2022 when new guidelines come out i'll just give you the new and updated information i hope you found this video helpful as always it would really support the channel if you give the video a thumbs up and then don't forget to subscribe and hit the notification bell because you want to get alerts when i post new episodes i will see you in the next episode and until then just keep on coding on [Music]