Observation Z Codes

January 29th, 2018 - Find-A-Code
Categories:   Diagnosis Coding   Billing  
0 Votes - Sign in to vote or comment.

There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected condition are present. In such cases the diagnosis/symptom code is used with the corresponding external cause code.

The observation codes are to be used as principal diagnosis only. The only exception to this is when the principal diagnosis is required to be a code from category Z38; Liveborn infants according to place of birth and type of delivery. Then a code from category Z05; Encounter for observation and evaluation of 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 Z03.7; Encounter for suspected maternal and fetal conditions ruled out, may either be used as a first-listed or as an additional code assignment 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 that encounter (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 coded. In addition, these codes are not for use if an illness or any signs or symptoms related to the suspected condition or problem are present. In such cases the diagnosis/symptom code is used.

Additional codes may be used in addition to the code from subcategory Z03.7, but only if they are unrelated to the suspected condition being evaluated.

Codes from subcategory Z03.7 may not be used for encounters for antenatal screening of mother. See Section I.C.21. Screening.

For encounters for suspected fetal condition that are inconclusive following testing and evaluation, assign the appropriate code from category O35, O36, O40 or O41.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Preview the PDGM Calculator for Home Health Today
December 4th, 2019 - Wyn Staheli, Director of Research
Until February 1, 2020, you can preview Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator by going to https://www.findacode.com/tools/home-health/ .
Hypertension ICD-10-CM Code Reporting Table
November 25th, 2019 - Wyn Staheli, Director of Research
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.
New Medicare Home Health Care Payment Grouper — Are You Ready?
November 25th, 2019 - Wyn Staheli, Director of Research
In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.
VA: How UCR Charges are Determined
November 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...
Medical Insurance Coverage for TMJ Disorders (TMD)
November 19th, 2019 - Christine Taxin
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
Changes to Portable X-Ray Requirements
November 19th, 2019 - Wyn Staheli, Director of Research
On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law.
Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
November 19th, 2019 - Wyn Staheli, Director of Research
Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?



About Codapedia by innoviHealth Contact Us Terms of Use Privacy Policy Advertise with Us

innoviHealth - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2000-2019 innoviHealth Systems, Inc. - CPT® copyright 2018 American Medical Association