Z Codes are very important particularly for social determinants of health. It is encouraged to keep this information (Z codes) as a secondary code for the purpose of data collection to better inform quality of care.
Z codes are ICD-10 codes indicating “Factors influencing health status and contact with health services” and subcategory “Persons with potential health hazards related to socioeconomic and psychosocial circumstances”.
Who decides on Z code limitations
Most of the limitations to the use of Z Codes are set by the payers. Some Z codes are limited by the level of licensing of the provider. CMS (Center for Medicare Services) usually leads the inclusion and exclusion rules and other insurance payers often follow.
Why we made this change
When a claim includes this code, it is to be used along with a primary diagnosis code that describes the disorder, illness or injury.
The “Z” code is secondary and falls within a broad category labeled “Factors Influencing Health Status and Contact with Health Services” and subcategory “Persons with potential health hazards related to socioeconomic and psychosocial circumstances”. For this reason this one code as primary, if it is a Z code, does not support medical necessity.
Z-code denials
Although payers may have paid some of these claims, the Z code does not indicate medical necessity. Insurance companies may or may not “catch” this error during initial claims processing.
If they catch the error, they will deny the claim.
If they don’t catch the error, they might never “reverse the decision." However, these claims are at risk for review– sometimes years after the date of service.
If you have had denied claims as a result of a Z Code, we may reach out to you and ask what diagnoses you would like to use as the primary diagnosis and resubmit your claims.
Ideally, with the Z code rules in place, we will prevent denied claims so that there will be no need for you to submit new information to correct the claims.
Determining the appropriate diagnosis
Often there are F codes that describe a symptom that would accurately represent the clinical presentation for which you might have only used a Z code.
Example
If you are treating someone suffering with loss and you had used Z63.4 - Disappearance and death of family member (Assumed death of a family member, Bereavement) the following have been seen to be used:
- The following adjustment disorder codes (which can be used for up to 6 months)
- F43.20 Adjustment disorder, unspecified (also listed in ICD-10 as Grief reaction)
- F43.21 Adjustment disorder, with depressed mood (also listed in ICD-10 as Grief)
- F43.29 Adjustment disorder, with other symptoms (also listed in ICD-10 as Prolonged Grief)
In the above example you can see that the ICD-10 guidelines use Grief as a descriptor to several codes that fall under the heading of adjustment disorder.
Although we cannot recommend a Diagnosis code for a primary Mental, Behavioral and Neurodevelopmental Disorder (F10-F99). Following each of the more commonly used Z codes below are some examples of primary diagnosis codes that have been used by other providers with the secondary Z codes.
For Z56.9 - Unspecified problems related to employment (includes Occupational Problems NOS):
Adjustment disorders (Can be used for up to 6 months)
- F43.20 Adjustment disorder, unspecified
- F43.21 Adjustment disorder, with depressed mood
- F43.22 Adjustment disorder, with anxiety
- F43.23 Adjustment disorder, with mixed anxiety and depressed mood
- F43.24 Adjustment disorder, with disturbance of conduct
- F43.25 Adjustment disorder, with mixed disturbance of emotions and conduct
- F43.29 Adjustment disorder, with other symptoms
Reaction to severe stress, unspecified, trauma and stressor-related disorder, NOS, Unspecified trauma and stressor-related disorder (New Text description)
Depression, unspecified; Depression NOS; Depressive Disorder NOS
Anxiety disorder, unspecified; Anxiety NOS
Generalized anxiety disorder, Anxiety reaction
Dysthymic disorder
Acute Stress Reaction, Acute Crisis Reaction, Acute Reaction to Stress
For Z60.0 - Problems of adjustment to life-cycle transitions (includes Empty nest syndrome, Phase of life problem, Problem with adjustment to retirement)
Adjustment disorders (Can be used for up to 6 months)
- F43.20 Adjustment disorder, unspecified (also listed in ICD-10 as Grief reaction)
- F43.21 Adjustment disorder, with depressed mood (also listed in ICD-10 as Grief)
- F43.22 Adjustment disorder, with anxiety
- F43.23 Adjustment disorder, with mixed anxiety and depressed mood
- F43.24 Adjustment disorder, with disturbance of conduct
- F43.25 Adjustment disorder, with mixed disturbance of emotions and conduct
- F43.29 Adjustment disorder, with other symptoms (also listed in ICD-10 as Prolonged Grief)
Reaction to severe stress, unspecified, trauma and stressor-related disorder, NOS, Unspecified trauma and stressor-related disorder (New Text description)
Depression, unspecified; Depression NOS; Depressive Disorder NOS
Anxiety disorder, unspecified; Anxiety NOS
Generalized anxiety disorder, Anxiety reaction
Dysthymic disorder
Acute Stress Reaction, Acute Crisis Reaction, Acute Reaction to Stress
For Z63.0 - Problems in relationship with spouse or partner (Relationship distress with spouse or intimate partner)
Adjustment disorders (Can be used for up to 6 months)
- F43.20 Adjustment disorder, unspecified (also listed in ICD-10 as Grief reaction)
- F43.21 Adjustment disorder, with depressed mood (also listed in ICD-10 as Grief)
- F43.22 Adjustment disorder, with anxiety
- F43.23 Adjustment disorder, with mixed anxiety and depressed mood
- F43.24 Adjustment disorder, with disturbance of conduct
- F43.25 Adjustment disorder, with mixed disturbance of emotions and conduct
- F43.29 Adjustment disorder, with other symptoms (also listed in ICD-10 as Prolonged Grief)
Reaction to severe stress, unspecified, trauma and stressor-related disorder, NOS, Unspecified trauma and stressor-related disorder (New Text description)
Depression, unspecified; Depression NOS; Depressive Disorder NOS
Anxiety disorder, unspecified; Anxiety NOS
Generalized anxiety disorder, Anxiety reaction
Dysthymic disorder
Acute Stress Reaction, Acute Crisis Reaction, Acute Reaction to Stress
For Z63.4 - Disappearance and death of family member (Assumed death of a family member, Bereavement)
Adjustment disorders (Can be used for up to 6 months)
- F43.20 Adjustment disorder, unspecified (also listed in ICD-10 as Grief reaction)
- F43.21 Adjustment disorder, with depressed mood (also listed in ICD-10 as Grief)
- F43.22 Adjustment disorder, with anxiety
- F43.23 Adjustment disorder, with mixed anxiety and depressed mood
- F43.24 Adjustment disorder, with disturbance of conduct
- F43.25 Adjustment disorder, with mixed disturbance of emotions and conduct
- F43.29 Adjustment disorder, with other symptoms (also listed in ICD-10 as Prolonged Grief)
Reaction to severe stress, unspecified, trauma and stressor-related disorder, NOS, Unspecified trauma and stressor-related disorder (New Text description)
Depression, unspecified; Depression NOS; Depressive Disorder NOS
Anxiety disorder, unspecified; Anxiety NOS
Generalized anxiety disorder, Anxiety reaction
Dysthymic disorder
Acute Stress Reaction, Acute Crisis Reaction, Acute Reaction to Stress
Disclaimer
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Benefits of coding according to the ICD-10 rules
As a provider you are the key responsible person for determining medical necessity. Using a “disorder, illness or injury” code as a primary diagnosis demonstrates medical necessity which would then be reflected in your notes.
Using the ICD-10 enables greater specificity in identifying mental health conditions. It also provides better data for measuring and tracking mental health care utilization and the quality of patient care.
This means that:
- You'll have fewer denials.
- As you work within the ICD-10 rules, your sessions are billed “cleaner” and there will be fewer requests for notes or additional information from the insurance companies.
Disclaimer
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
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