Z Codes and Reproductive Services Challenge – Coding Guidelines

In this challenge, you are being tested on the ICD-10-CM coding guidelines on Z codes, specifically those related to reproductive services. Try to answer the question correctly and then review the rationales below. Afterward, try your luck on another coding scenario provided at the bottom of this post.

image of mom and baby right after birth to go along with post on Z codes and Reproductive Services Coding Challenge

Question: A Z code from one of the following categories is listed on the maternal record when a delivery occurs during the admission. This code is never listed first.

A. Z37
B. Z34
C. Z38
D. Z33

As mentioned above, you need to understand the coding guidelines related to Z codes and reproductive services to answer this question correctly. Let’s review them below.

Z Codes and Reproductive Services

According to the ICD-10-CM Official Guidelines for Coding and Reporting,

“Z codes (other reasons for healthcare encounters) may be assigned as appropriate to further explain the reasons for presenting for healthcare services, including transfers between healthcare facilities, or provide additional information relevant to a patient encounter. The ICD-10-CM Official Guidelines for Coding and Reporting identify which codes may be assigned as principal or first-listed diagnosis only, secondary diagnosis only, or principal/first-listed or secondary (depending on the circumstances).”

Chapter 21 – Z Codes (Z30-Z39)

In ICD-10-CM, Z codes (Z00-Z99) are located in Chapter 21. Factors Influencing Health Status and Contact with Health Services.

Z code categories related to reproductive services are found in the section called Persons Encountering Health Services in Circumstances Related to Reproduction (Z30-Z39). The categories within this section include:

  • Z30, Encounter for contraceptive management
  • Z31, Encounter for procreative management
  • Z32, Encounter for pregnancy test and childbirth and childcare instruction
  • Z33, Pregnant state
  • Z34, Encounter for supervision of normal pregnancy
  • Z36, Encounter for antenatal screening of mother
  • Z37, Outcome of delivery
  • Z38, Liveborn infants according to place of birth and type of delivery
  • Z39, Encounter for maternal postpartum care and examination
  • Z3A, Weeks of gestation

If you look up the categories provided in answers A, B, C, and D, you will see that the descriptors are:

  • Z37, Outcome of delivery
  • Z34, Encounter for supervision of normal pregnancy
  • Z38, Liveborn infants according to place of birth and type of delivery
  • Z31, Encounter for procreative management

Z37 looks like the correct answer just by looking at the descriptors because the question involves a delivery, and we are talking about the mother’s record. However, let’s take a closer look.

The codes in category Z37 describe the number of births and if the birth(s) were liveborn or stillborn. The coding guidelines tell us that category Z37 is intended for use as an additional code to identify the outcome of delivery on the mother’s record. The coding guidelines further state, “A code from category Z37, Outcome of delivery, should be included on every maternal record when a delivery has occurred. These codes are not to be used on subsequent records or the newborn record.”

So, it appears we have our answer. A code from category Z37, Outcome of delivery, is listed on the maternal record when a delivery occurs during the admission. This code is used as an additional code and is never listed first.

Remember, some Z codes are only used on the maternal record. Still, others are only used on the baby’s record.

Correct Answer: A. Z37, Outcome of delivery

Incorrect Answers

B, C, and D are incorrect.

B. Z34. Z34 describes Encounter for supervision of normal pregnancy. A code from this category is used to identify patient encounters for the supervision of a pregnant woman. The individual codes from this category identify first pregnancy, normal pregnancy, or other types of pregnancy. The trimester is also included in the code descriptors.

The guidelines state, “Codes in category Z34, Encounter for supervision of normal pregnancy, are always first listed and are not to be used with any other code from the OB chapter.”

C. Z38. Z38 describes Liveborn infants according to place of birth and type of delivery. A code from this category is used to report the number of liveborn infants, whether born in or outside the hospital or unspecified.

The guidelines state, “When coding the birth episode in a newborn record, assign a code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis. A code from category Z38 is assigned only once to a newborn at the time of birth. If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital. A code from category Z38 is used only on the newborn record, not on the mother’s record.”

D. Z31. Z31 describes Encounter for procreative management. A code from this category is used to report the assessment of a patient’s fertility status, reversal of contraception and/or sterilization status, the investigation into genetic carrier status, family planning, and other issues related to the planning of children.

The coding guidelines state that certain “Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined.” The Z codes mentioned from category Z31 include:

  • Z31.81 Encounter for male factor infertility in female patient
  • Z31.83 Encounter for assisted reproductive fertility procedure cycle
  • Z31.84 Encounter for fertility preservation procedure

Another Coding Challenge

Now that we have solved that problem (question,) see if you can assign the correct ICD-10-CM code(s) for the following scenario. Then look at the answer and rationale.

A 24-year-old female is admitted for a full-term normal delivery. A single, healthy infant is delivered without complications. Assign for ICD-10-CM.

You are being asked to code for the maternal record.

Locate and Verify

In the coding manual Index, look under Delivery (childbirth) (labor)/normal O80. This code can be verified in the Tabular as:

O80, Encounter for full-term uncomplicated delivery

Delivery requiring minimal or no assistance, with or without episiotomy, without fetal manipulation [e.g., rotation version] or instrumentation [forceps] of a spontaneous, cephalic, vaginal, full-term, single, live-born infant.

Codes from Chapter 15. Pregnancy, Childbirth, and the Puerperium (O00-O9A) are only for use on maternal records, never on newborn records.

There is a note to use additional code to indicate outcome of delivery (Z37.0)

This code is for use as a single diagnosis code and is not used with any other code from chapter 15.

When we go to Z37.0 in the Tabular, Z37.0 refers to Single live birth.

Z37.0 must be reported on a mother’s medical record. It cannot be reported on a newborn’s record.

Code O80 is always the principal diagnosis, followed by the Z37.0 code.

If the weeks of gestation are documented, a code from category Z3A should also be assigned.

Answer: O80, Z37.0


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