1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THE COMPLETE DIAGNOSIS CODING SOLUTION THIRD EDITION Chapter 22 Factors Influencing Health Status and Contact with Health Services 22-1

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes 22.1 Abstract details about preventive services. 22.2 Determine reasons for early detection. 22.3 Demonstrate how to report encounters related to genetic susceptibility. 22.4 Accurately report the reasons for observation services. 22-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes (cont.) 22.5 Apply the Official Guidelines for reporting aftercare and follow-up care. 22.6 Interpret documentation for reporting obstetrics and neonatal exams. 22.7 Distinguish indications of antimicrobial drug resistance. 22.8 Employ Z codes accurately. 22-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Abnormal findings Allogeneic Autologous Carrier Isogeneic 22-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Preventive care Prosthetic Screening Xenogeneic 22-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction There are occasions for patients to seek attention even when they are not currently ill. These codes give you the opportunity to explain. 22-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Preventive Care Science and research have provided us with a better understanding of disease and disease progression, as well as etiology. This knowledge has evolved into improved preventive care services to stop the onset of illness or injury. Learning Outcome: 22.1 22-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Early Detection Routine and administrative exams ensure continued good health by looking for signs of disease as early as detection may be possible. Commonly, these health care encounters are known as annual physicals, well-baby checks, or well-woman exams. Learning Outcome: 22.2 22-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Early Detection (cont.) These routine encounters, most often prompted by the calendar, are reported with Z codes. – Z00.00, Encounter for general adult medical examination without abnormal findings. A screening is a test or examination, such as routine lab work or imaging services, administered when there are no current signs, symptoms, or related diagnosis. Learning Outcome: 22.2 22-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Genetic Susceptibility A patient might be a carrier or suspected carrier of a disease. The patient may have an abnormal gene that may increase a patient’s chances of developing a disease. In most cases, documentation will note that the patient has a family history of a condition, such as code Z80.6, Family history of leukemia. Learning Outcome: 22.3 22-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Observation There might be a reason that a physician suspects a patient may be ill despite the absence of signs and symptoms. Code categories Z03 and Z04 enable you to report the reason these types of encounters are medically necessary. Learning Outcome: 22.4 22-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Continuing Care and Aftercare Chronic illness may require long-term use of medication, known as drug therapy. When a patient is taking any type of pharmaceutical on an ongoing basis, regular monitoring can identify potential concerns, such as side effects or loss of potency. Learning Outcome: 22.5 22-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Continuing Care and Aftercare (cont.) When coding an encounter for such monitoring, you may begin with Z51.81, Encounter for therapeutic drug level monitoring, along with a code to identify the type of therapeutic drug, such as Z79.01, Long term (current) use of anticoagulants, or Z79.811, Long term (current) use of aromatase inhibitors. Learning Outcome: 22.5 22-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Obstetrics (Prenatal) and Neonatal Exams Once the baby has arrived, the outcome of delivery, birth status, and health supervision and observations of an infant or child are all reported with a Z code such as Z00.1100, Health examination for newborn under 8 days old. Learning Outcome: 22.6 22-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Organ Donation The number of organs and tissues that can be successfully transplanted has dramatically increased over the years, and many can be provided by a living donor. Code category Z52, Donors of organs and tissues, includes various types of blood donors (Z52.0), skin donors (Z52.1), and bone donors (Z52.2). Learning Outcome: 22.6 22-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Organ Donation (cont.) The donations of any of these organs would almost always be used as an allogeneic donation to another individual. A donation from the recipient’s monozygotic twin is called isogeneic, while a xenogeneic donation involves a donor and recipient who are of different species. Synthetic organ and tissue replacements are referred to as prosthetic. Learning Outcome: 22.6 22-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Resistance to Antimicrobial Drugs The World Health Organization (WHO) defines antimicrobial resistance (AMR) as the “resistance of a micro-organism to an antimicrobial medicine to which it was originally sensitive.” AMR may be the result of overuse of antibiotics. Learning Outcome: 22.7 22-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Resistance to Antimicrobial Drugs (cont.) ICD-10-CM provides a note with some directions about the proper use of the Z codes: Note: The codes in this category are provided for use as additional codes to identify the resistance and non- responsiveness of a condition to antimicrobial drugs. Learning Outcome: 22.7 22-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Z Codes as First-Listed/Principal Diagnosis During most encounters, a Z code may be the only code you report, or it may be reported along with others, determined by the specific circumstances. Except for 20 of the Z codes, sequencing is determined by the facts of the encounter and the Official Guidelines, as explained in Sections II and III. Learning Outcome: 22.8 22-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary As a professional coder, you are responsible to ensure that every physician-patient encounter is supported as medically necessary. In ICD-10-CM, virtually all of the codes used to explain these valid reasons are found in the Z code chapter. 22-20