ICD-10 Guide

Z11.1

Encounter for screening for respiratory tuberculosis

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z11.1 is a billable code used to indicate a diagnosis of encounter for screening for respiratory tuberculosis.

Key Diagnostic Point:

Z11.1 is used to indicate an encounter for screening for respiratory tuberculosis (TB), a contagious bacterial infection primarily affecting the lungs. This screening is crucial for early detection and prevention of TB, especially in populations at higher risk, such as those with compromised immune systems, individuals living in crowded conditions, or those with a history of exposure to TB. Social determinants of health, such as socioeconomic status, access to healthcare, and living conditions, significantly influence the risk of TB infection and the likelihood of seeking preventive care. Preventive screenings like this are essential in public health strategies to control and reduce the incidence of TB, particularly in endemic areas. Proper documentation of risk factors, patient history, and screening results is vital for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Need for thorough patient history to identify risk factors.
Documentation of screening results and follow-up plans.
Understanding of social determinants affecting TB risk.
Potential for co-morbid conditions that may complicate coding.

Audit Risk Factors

Inadequate documentation of risk factors or screening results.
Failure to follow up on abnormal screening results.
Incorrect sequencing of Z codes with primary diagnosis.
Lack of clarity on the reason for the screening encounter.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, risk factors, screening results, and follow-up plans.

Common Clinical Scenarios

Routine checkups where TB screening is indicated based on risk factors.

Billing Considerations

Consider social determinants such as housing stability and access to healthcare services.

Public Health

Documentation Requirements

Collect data for epidemiological tracking and community health assessments.

Common Clinical Scenarios

Community outreach programs offering TB screenings in high-risk populations.

Billing Considerations

Focus on population health metrics and reporting requirements.

Coding Guidelines

Inclusion Criteria

Use Z11.1 When

Z codes should be used when the encounter is for screening purposes without a current diagnosis
1 should be sequenced appropriately, often as a secondary code following a primary diagnosis
Payer requirements may vary, so it is essential to verify coverage for preventive services

Exclusion Criteria

Do NOT use Z11.1 When

No specific exclusions found.

Related CPT Codes

86580CPT Code

Tuberculin skin test

Clinical Scenario

Used in conjunction with Z11.1 for TB screening.

Documentation Requirements

Document the test results and any follow-up actions.

Specialty Considerations

Primary care providers should ensure proper follow-up for positive results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters for screening, enhancing the ability to track and manage public health concerns like TB.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters for screening, enhancing the ability to track and manage public health concerns like TB.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters for screening, enhancing the ability to track and manage public health concerns like TB.

Resources

Clinical References

•
CDC Tuberculosis Screening Guidelines

Coding & Billing References

•
CDC Tuberculosis Screening Guidelines

Frequently Asked Questions

When should Z11.1 be used instead of a diagnostic code?

Z11.1 should be used when the encounter is specifically for screening purposes without a current diagnosis of TB. It is essential to document the reason for screening and any risk factors present.

ICD-10 Z11.1 is a billable code used to indicate a diagnosis of encounter for screening for respiratory tuberculosis.