Code First Notes in Chapter 21: Factors influencing health status and contact with health services ICD-10-CM
A Code First note means the underlying condition named in the note is sequenced before this code. In Chapter 21 (Z00-Z99), notes printed in the chapter name other codes 30 times, and Code First Notes anywhere in the Tabular List name the chapter’s codes 3 times, covering 2 distinct codes, categories and ranges. Switch views to read the list either way.
Code First Notes by the code that carries the note
- Z21 Asymptomatic human immunodeficiency virus [HIV] infection status
- Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium, if applicable (O98.7-)
- Z79.81 Long term (current) use of agents affecting estrogen receptors and estrogen levels applies to 3 codes
- any follow-up examination after treatment of malignant neoplasm (Z08)
- any follow-up examination after treatment (Z09)
- any follow-up examination after treatment (Z09)
- Z91.83 Wandering in diseases classified elsewhere
- Z91.A3 Caregiver's unintentional underdosing of patient's medication regimen
- Z92.82 Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility
- Z99.3 Dependence on wheelchair
- Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
- Z85 Personal history of malignant neoplasm: any follow-up examination after treatment of malignant neoplasm (Z08)
- Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
The first view lists notes printed in this chapter (a note on a category or block applies to every code beneath it). The second lists codes of this chapter named by Code First Notes anywhere in the Tabular List, including notes in other chapters.
Questions About Code First Notes
What does a Code First note mean?
A Code First note means the underlying condition named in the note is sequenced before the code that carries the note. Under the etiology/manifestation convention, a “code first” note appears at the manifestation code and a “use additional code” note at the etiology code (Section I.A.13). The FY 2027 Tabular List has 810 of them; 600 name other codes, with 736 references to 429 distinct codes, categories and ranges.
Can a code with a Code First note be the principal diagnosis?
Not when it is a manifestation code. Codes titled “in diseases classified elsewhere” are never permitted as the first-listed or principal diagnosis; they must follow the underlying condition. The etiology and manifestation page lists them all.
Related References
Source: FY 2027 ICD-10-CM Tabular List (CMS and NCHS) and the ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section I.A. ICD List is not affiliated with CMS or NCHS.
