Part 1: Top 3 CM Chapters 2019 from ProFee Reviews

In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients.  Below are the top three ICD-10-CM chapters where HIA identified coding opportunities.

  1. Z00-Z99 – Factors influencing health status and contact with health services
  2. I00-I99 – Circulatory system
  3. R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

For part 1 of this 3-part series, we will look at Z00-Z99 – Factors influencing health status and contact with health services.

Z00-Z99 – Factors influencing health status and contact with health services:

The “Z” code chapter has 15 sections which are then broken down into categories.  Below are a few areas where coding opportunities were identified during HIA reviews:

  • Z13 – Encounter for screening for other diseases and disorders (encounter for screening for malignant neoplasms, encounter for screening mammogram, etc.) It’s important to remember these codes should be assigned when the screening takes place not when the order for screening was written/entered.  During reviews it was noted that many encounters had the screening codes assigned when the order was written/entered for the screening to be done at a later date.  Several facilities identified this as an issue where the order entry system would automatically assign the screening code when the provider entered the order.  Your IT department should be able to help correct this if you identify the same issue.

References:  ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 21. Chapter 21:  Factors influencing Health Status and Contact with Health Services.  5.  Screening. 

  • Z68 – Body mass index (BMI). When assigning the BMI codes, it’s important to remember the guidelines.  There are BMI adult codes for patients 20 years and older and pediatric codes for patient’s 2-19 years of age.  Also remember BMI wouldn’t be assigned for patient’s that are pregnant.  Coding opportunities for this category were using the incorrect BMI in relation to the age, reporting BMI on patients that are pregnant and lastly not reporting the BMI when documentation was present and met the reporting guidelines.

References:  Coding Clinic, Fourth Quarter ICD-10 2018 Page 81; ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 21. Chapter 21:  Factors influencing Health Status and Contact with Health Services.  2.  Status.   

  • Z85 through Z87 – Personal history of malignant neoplasms, certain other diseases, and other diseases and conditions. Changes in these categories were due to the following:
    • Assigning a personal history code when documentation supported a family history and not a personal history.
    • Assigning an unspecified history code when documentation in the record supported a more specific code assignment.
    • Not assigning the personal history code when documentation supported the assignment and history was relevant to the encounter.

References:  ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 21. Chapter 21:  Factors influencing Health Status and Contact with Health Services.  4 History Of 

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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