How and When to Use Z Codes

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.

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

Document and bill services with ease.

TherapyNotes™ features robust note templates with searchable ICD-10 codes and easy electronic billing. Talk with a member of our Success team to learn more.