How and When to Use Z Codes

By TherapyNotes, LLC on July 11, 2018
How and When to Use Z Codes - TherapyNotes

Many therapists have clients who need therapy but do not meet requirements for a diagnosis. These situations, while not a problem to treat, can be difficult to bill. Thankfully, there are diagnosis codes for that called Z codes.


What are Z codes?

Z codes (Z00–Z99) are diagnosis codes used for situations where patients don’t have a known disorder, which could arise in two ways:

  • When a person, who may or may not be sick, encounters health services for some specific purpose, such as to receive limited care or service for a current condition or to discuss a problem which is in itself not a disease or injury
  • When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury

These codes—which replaced V codes in the ICD-10—are 3–6 characters long. They can be billed as first-listed codes in specific situations, like aftercare and administrative examinations, or used as secondary codes.


Common Z codes for therapists

Here are some common Z codes you may use in your practice:

  • Z00.4 (general psychiatric examination, not elsewhere classified)
  • Z03.2 (observation for suspected mental and behavioral disorders)
  • Z04.6 (general psychiatric examination, requested by authority)
  • Z09.3 (follow-up examination after psychotherapy)
  • Z13.3 (special screening examination for mental and behavioral disorders)
  • Z13.4 (special screening examination for certain developmental disorders in childhood)
  • Z50.4 (psychotherapy, not elsewhere classified)
  • Z54.3 (convalescence following psychotherapy)
  • Z71.1 (person with feared complaint in whom no diagnosis is made)
  • Z71.9 (counseling, unspecified)
  • Z81.8 (family history of other mental and behavioral disorders)
  • Z91.4 (personal history of psychological trauma, not elsewhere classified)

For a complete list of Z codes, check out the World Health Organization’s ICD-10 online browser.

For TherapyNotes™ users: TherapyNotes™ includes many common ICD-10 codes by default, but you can also add custom diagnosis codes to fit your needs and specialty. For more information, visit our help center and read How To: View, Add, and Delete Diagnosis Codes.


Are Z codes worth using?

One downfall of Z codes is that they’re not always covered by insurance.

Because of this, some therapists don’t think it’s worth using these codes. They’d rather not risk wasting their client’s time submitting a claim if it may possibly get rejected by the insurance company. Other therapists feel more confident taking that risk. It varies on a case-by-case basis and is up to you.

If you don’t want to use Z codes, though, you could use adjustment disorder codes instead. These are codes that acknowledge emotional or behavioral symptoms while deferring a specific diagnosis for up to six months. They’re typically reimbursable and can be found under F43.2 in the ICD-10.

We’ll cover other codes in future posts, so make sure you subscribe to the TherapyNotes™ blog below for more helpful information.


Sources: ICD-10 Version:2016, World Health Organization; From V Codes to Z Codes: Transitioning to ICD-10 (Updated), The American Health Information Management Association; Adjustment Disorder Symptoms, Psych Central; Z Codes That May be Principal/First-Listed Diagnosis, California Health Information Association; Bereavement Coding Fact Sheet, American Academy of Pediatrics

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* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.


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