Solution Manual For Pearsons Comprehensive Medical Coding 2nd Edition Lorraine M Papazian Boyce

Solution Manual for Pearsonâ€™s Comprehensive Medical Coding, 2nd Edition, Lorraine M.
Papaz
Solution Manual for Pearsonâ€™s Comprehensive

Medical Coding, 2nd Edition, Lorraine M.
Papazian-Boyce
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CHAPTER 6: FACTORS INFLUENCING HEALTH STATUS AND CONTACT
WITH HEALTH SERVICES (Z00–Z99)
INSTRUCTIONAL AND LEARNING OBJECTIVES:
After completing this chapter, students should have the skills to:
6.1 Spell and define the key words, medical terms, and abbreviations related
to factors influencing health status and contact with health services.
(Remember)
6.2 Describe the purpose of codes for factors influencing health status and
contact with health services. (Understand)
6.3 Adhere to the Official Guidelines for Coding and Reporting related to
factors influencing health status and contact with health services. (Apply)
6.4 Examine and abstract information required for coding factors influencing
health status and contact with health services from the medical record.
(Analyze)
6.5 Demonstrate how to assign codes for factors influencing health status and
contact with health services. (Apply)
6.6 Utilize guidelines for arranging (sequencing) codes for factors influencing
health status and contact with health services and related conditions.
(Apply)
CHAPTER OUTLINE
• Purpose of Z Codes
• Coding Guidelines for Z Codes
Copyright © 2020. Pearson Education

• Abstracting for Z Codes
• Assigning Z Codes
• Arranging Z Codes
RESOURCES
• Student textbook, Chapter 6
• Instructor’s Manual with Lesson Plans
• Chapter 6 PowerPoint Lecture
• Chapter 6 Image Library
DETAILED LESSON PLANS
Learning Objective 6.1:
Spell and define the key words, medical terms, and abbreviations related to
factors influencing health status and contact with health services.
Concepts for Lecture:
1. The key terms listed at the beginning of chapter are important concepts for
students to know, and appear in blue boldface type throughout the chapter.
2. Students should also become familiar with the terms listed within tables in the
chapter.
Teaching Notes
Teaching Resource:
Pearson’s Comprehensive Medical Coding: A Path To Success, Chapter 6

PowerPoint Lecture Slides:
Teaching Notes/Tips:
1. In healthcare, patients receive services even though they are not ill or injured.
They may seek annual physical examinations, vaccinations, screening
examinations, follow-up care, or maternity care. Physicians need to track
information about patients’ health status, health history, and health risks that
do not present current problems but could in the future. In this chapter,
students will learn how to use I CD-10-CM codes for these purposes.
2. Although Z codes appear at the end of the ICD-10-CM classification, this text
suggests teaching them early in the course. This way, students can gain skills
using Z codes throughout all of the body system chapters.
3. This chapter has only two Key Terms because there are few medical terms
unique to Z codes. It is important that students learn the definitions of each Z
code category shown in Table 6-1.
Describe the purpose of codes for factors influencing health status and contact
with health services.
1. Z codes represent reasons for encounters, and may be used in any
healthcare setting when the reason for the encounter is not a disease, injury,
or external cause that is classified in the preceding ICD-10-CM chapters for
body systems (A00–Y99):

a. A person encounters the health services for some specific purpose which,
in itself, is not a disease or injury.
b. A circumstance or problem exists that influences the person's health
status but is not, in itself, a current illness or injury.
Teaching Notes
Teaching Resource:
Tables:
6-1 Definitions and Examples of Z Code Categories
In-Class Activities:
Review Table 6-1 and show students how to locate this information in the O GCR.
1. ICD-10-CM Chapter 21 classifies factors influencing health status and contact
with health services. For the sake of brevity, this text refers to this chapter as
Z codes.
2. Although students do not need to memorize specific codes, it is helpful to
memorize the Z code categories and definitions. By knowing the
circumstances in which Z codes are required, students will become more
accurate when abstracting.

Homework Assignment:
Coding Practice, Exercise 6.1, Introduction to Z Codes, #1–3d
Adhere to the Official Guidelines for Coding and Reporting related to factors
influencing health status and contact with health services.
1. ICD-10-CM Chapter 21, Factors Influencing Health Status and Contact with
Health Services (Z00–Z99), contains 15 blocks or subchapters.
2. ICD-10-CM provides Official Guidelines for Coding and Reporting (OGCR) Z
codes in OGCR section I.C.21.
a. Additional OGCR related to Z codes appear throughout the guidelines:
i. I.B.3, I.C.1.a. (HIV)
ii. I.C.2. (neoplasms)
iii. I.C.4. (endocrine)
iv. I.C.15. (obstetrics)
v. I.C.19. (injuries)
vi. I.C.20. (external causes)
vii. Ⅳ.B. (outpatient services)
b. In the Tabular List, instructional notes throughout all chapters alert coders
to many circumstances that require Z codes.
3. OGCR references are provided throughout the student text, when applicable
to the topic discussed.

Teaching Notes
Teaching Resource:
1. Have students open the ICD-10-CM coding manual to the beginning of
Chapter 21 (Z00–Z99), and review the structure of the chapter with them.
2. Have students open the OGCR to section I.C.21. and review the guidelines
with them.
1. In ICD-10-CM, the codes are part of the regular classification rather than
being a supplementary classification.
Examine and abstract information required for coding factors influencing health
status and contact with health services from the medical record.
1. Because Z codes are applicable to a wide variety of situations, there is no
one concise rule that guides coders when Z codes are needed.
2. When Z code(s) describe the main reason for the encounter, identify the main
reason for the encounter, then search for the Main Term in the Index to locate
the Z codes.

3. In many circumstances, the Tabular List provides instructional notes directing
the coder to assign certain types of Z codes.
4. When the Tabular List does not provide specific guidance regarding the use
of Z codes, coders must rely on their knowledge of OGCR to know when a Z
code is required.
5. Guided Example of Z Codes
a. Refer to the Guided Example of patient Angela Holmes, who was seen at
Branton Medical Center Outpatient Procedure Clinic for a screening
colonoscopy, throughout the chapter to help students learn skills for
abstracting and assigning Z codes.
Teaching Notes
Teaching Resource:
Tables:
6-2 Key Criteria for Abstracting Z Codes
Figures:
6-1 Example of instructional notes in Tabular List requiring Z codes (category
I20).

Refer to Table 6-2. Discuss the following question as a class, in small groups, or
on an online discussion board:
• What patient examples can you think of in which a Z code would be
required?
1. In Table 6-2, locate the patient situation in the left column, then refer to the
appropriate Main Term in the right column.
2. Discuss with students the difference between a current condition and the
history of a condition.
Coding Practice, Exercise 6.2, Abstracting for Z Codes, # 1–6
Demonstrate how to assign codes for factors influencing health status and
contact with health services.
1. To locate the Main Term for a Z code, identify the noun that describes the
reason or purpose of the encounter.
2. When the reason for the encounter is a screening examination or specific
health service, the title of the Z code may look like a procedure code.
a. Assign the Z code for the diagnosis—the reason for the encounter.

b. Assign an ICD-10-PCS or CPT code for the procedure—the service
provided.
3. Do not use Z codes in certain circumstances:
a. Do not assign a Status Z code when the diagnosis code from the body
system chapter includes the same information.
b. Do not assign Aftercare Z codes when the patient has a current condition
that is coded from a body system chapter.
4. Guided Example of Assigning Z Codes
a. Continue with the example from earlier in the chapter about Angela
Holmes, who was seen at Branton Medical Center Outpatient Procedure
Clinic for a screening colonoscopy.
b. Z12.11, Encounter for screening for malignant neoplasm of colon
Teaching Notes
Teaching Resource:
Tables:
6-3 Commonly Used Main Terms for Z Codes
Figures:
6-2 Example of a diagnosis code that overrides the need for a Z code.
6-3 Index entry for the Main Term “Screening.”
6-4 Tabular List entry for category Z12 and code Z12.11.

Walk through the Guided Example of Assigning Z Codes and have students
follow along in the ICD-10-CM Index and Tabular List.
Coding Practice, Exercise 6.3, Assigning Z Codes, # 1–3
Utilize guidelines for arranging (sequencing) codes for factors influencing health
status and contact with health services and related conditions.
1. OGCR I.C.21.c.16) lists the Z codes and categories that may only be reported
as the principal or first-listed diagnosis.
2. Instructional notes in the Tabular List and OGCR from other chapters provide
direction for Z code sequencing.
3. OGCR I.C.2.e provides additional guidelines. Therefore, coders must review
all the OGCR related to an encounter and apply critical thinking skills to
compare and contrast the guidelines.
4. Any code listed in OGCR I.C.21.c.16) may be assigned as the only diagnosis
code for an encounter, which is often the case when patients seek specific
health services.
5. Any code not listed in OGCR I.C.21.c.16) may be used as a secondary, or
additional, diagnosis code. When no specific OGCR exists for sequencing a Z
code, follow OGCR that apply to sequencing all diagnosis codes.

Teaching Notes
Teaching Resource:
When an episode of care involves the surgical removal of a neoplasm, followed
by adjunct chemotherapy or radiation therapy during the same episode of care,
sequence the neoplasm code first, then assign any additional diagnoses.
When more than one type of antineoplastic therapy is provided during the same
encounter, either may be sequenced first.
The Guided Example in this chapter does not require sequencing.
Coding Practice, Exercise 6. 4, Arranging Z Codes, # 1–3
CHAPTER 6 REVIEW
1. Z codes represent reasons for encounters and may be used in any healthcare
setting when the reason for the encounter is not a disease, injury, or external
cause that is classified in the preceding ICD-10-CM chapters for body
systems (A00–Y99).
2. ICD-10-CM Chapter 21, Factors Influencing Health Status and Contact with
Health Services (Z00–Z99), reports reasons for encounters that are not due

to a current illness or injury or to report health status or risk factors
documented as significant by the physician.
3. ICD-10-CM provides Official Guidelines for Coding and Reporting (OGCR) Z
codes in OGCR section I.C.21., which contains a detailed discussion of the
categories of Z codes, when to report them, and which codes may only be
sequenced as the principal or first-listed diagnosis.
4. Coders abstract information described by Z codes in three different types of
circumstances: when Z codes describe the reason for the encounter; when
instructional notes in the Tabular List direct coders to use Z codes; and when
Z codes are required by the OGCR only.
5. When assigning Z codes, coders need to know for which Main Terms to
search in the Index, how to distinguish between diagnosis codes and
procedure codes, and when not to use a Z code.
6. Instructional notes in the Tabular List and the OGCR provide sequencing
guidance regarding which Z codes are permitted only as the principal or first-
listed diagnosis code and which may be the sole diagnosis code or additional
(secondary) diagnosis codes.
Teaching Notes
Teaching Resource:
Concept Quiz, Completion, #1–10

Solution Manual for Pearsonâ€™s Comprehensive Medical Coding, 2nd Edition, Lorraine M. Papaz
Concept Quiz, Multiple Choice, #1–10
Keep On Coding, #1–25
Coding Challenge, #1–10
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WITH HEALTH SERVICES (Z00–Z99)

INSTRUCTIONAL AND LEARNING OBJECTIVES:

to factors influencing health status and contact with health services.

contact with health services. (Understand)

contact with health services. (Apply)

• Coding Guidelines for Z Codes

Copyright © 2020. Pearson Education

• Student textbook, Chapter 6

• Instructor’s Manual with Lesson Plans

• Chapter 6 PowerPoint Lecture

• Chapter 6 Image Library

DETAILED LESSON PLANS

Learning Objective 6.1:

factors influencing health status and contact with health services.

Concepts for Lecture:

Pearson’s Comprehensive Medical Coding: A Path To Success, Chapter 6

Copyright © 2020. Pearson Education

They may seek annual physical examinations, vaccinations, screening

examinations, follow-up care, or maternity care. Physicians need to track

using Z codes throughout all of the body system chapters.

unique to Z codes. It is important that students learn the definitions of each Z

code category shown in Table 6-1.

Learning Objective 6.2:

with health services.

Concepts for Lecture:

1. Z codes represent reasons for encounters, and may be used in any

or external cause that is classified in the preceding ICD-10-CM chapters for

body systems (A00–Y99):

Copyright © 2020. Pearson Education

in itself, is not a disease or injury.

b. A circumstance or problem exists that influences the person's health

status but is not, in itself, a current illness or injury.

Pearson’s Comprehensive Medical Coding: A Path To Success, Chapter 6

PowerPoint Lecture Slides:

6-1 Definitions and Examples of Z Code Categories

1. ICD-10-CM Chapter 21 classifies factors influencing health status and contact

2. Although students do not need to memorize specific codes, it is helpful to

memorize the Z code categories and definitions. By knowing the

circumstances in which Z codes are required, students will become more

accurate when abstracting.

Copyright © 2020. Pearson Education

Coding Practice, Exercise 6.1, Introduction to Z Codes, #1–3d

Learning Objective 6.3:

influencing health status and contact with health services.

Concepts for Lecture:

Health Services (Z00–Z99), contains 15 blocks or subchapters.

2. ICD-10-CM provides Official Guidelines for Coding and Reporting (OGCR) Z

codes in OGCR section I.C.21.

a. Additional OGCR related to Z codes appear throughout the guidelines:

i. I.B.3, I.C.1.a. (HIV)

ii. I.C.2. (neoplasms)

iii. I.C.4. (endocrine)

iv. I.C.15. (obstetrics)

vi. I.C.20. (external causes)

vii. Ⅳ.B. (outpatient services)

to many circumstances that require Z codes.

to the topic discussed.

Copyright © 2020. Pearson Education

Pearson’s Comprehensive Medical Coding: A Path To Success, Chapter 6