June 18, 2020
What are CPT® Category II and Z codes?
CPT Category II codes are performance measurement tracking codes. Z codes are health status diagnosis codes. Certain CPT II codes and Z codes facilitate data collection for the Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Used together, they can give you credit for quality of care without the need for medical record review and can help close gaps for HEDIS measures.
CPT Category II codes describe clinical performance measures that are usually included in the evaluation and management process such as A1c or blood pressure values. They’re entered in the procedure code field similar to CPT Category I codes.
Z codes are ICD-10 diagnosis codes that describe a patient’s health status. They’re used to exclude patients from measures. For example, patients who can’t tolerate statin medication can be excluded from the Statin Therapy for Patients with Cardiovascular Disease (SPC) measure by submitting a claim with the appropriate Z code to indicate the diagnosed condition.
View a claims coding tip sheet with frequently used CPT II and ICD-10 codes for HEDIS measures.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.