Inpatient Rehabilitation: Coding Z Codes

by Nirmala Sivakumar, CCS, CDIP

Question: Should Z codes be recorded under comorbid conditions (item 24) on the IRF-PAI (Inpatient Rehabilitation Facility – Patient Assessment Instrument)?

Answer: The IRF-PAI training manual defines a comorbid condition as a secondary condition a patient has in addition to the primary diagnosis for which the patient was admitted to the IRF.

The patient’s comorbidity/ies listed in Item 24 of the IRF-PAI should have significant impact on the patient’s course of treatment for the primary diagnosis. The IRF-PAI provides 25 spaces to record ICD-10 codes.

If the Z codes are relevant to the patient’s rehab stay, they should be recorded. Some examples of relevant Z codes would be dialysis status, tracheostomy status, Body Mass Index, aftercare following surgery, joint replacement status, etc.

DNR status, allergy to medications, family history of conditions, etc. do not have any impact on the patient’s course of treatment in acute rehab and need not be reported on the IRF-PAI.

Use the 25 spaces wisely to tell the story with your codes on why the patient needs acute inpatient rehab.


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About the author

Nirmala Sivakumar, CCS, CDIP
Nirmala Sivakumar is an IRF Coding Educator based in PA. She has created and presented many webinars and workshops on IRF coding and improving clinical documentation. She has trained and mentored many rehab coders. She also has experience in conducting coding audits. She enjoys sharing her expertise and knowledge and has a desire to help coders and PPS Coordinators overcome the challenges of IRF PPS coding.

She has held previous positions as Health Information Management Supervisor for one of HealthSouth’s (Encompass) acute inpatient rehab hospital and as a HIM Coding Consultant at Uniform Data Systems for Medical Rehabilitation. She can be reached at [email protected] or visit

About the Author

Libman Education
Libman Education Inc. is a leading provider of training for the health care workforce offering self-paced and instructor-led online courses designed and developed by leading industry experts in Health Information Management (HIM) and Medical Record Coding. Our courses are specifically designed to improve individual skills and increase the efficiencies and competencies of health care providers and institutions. At Libman Education, we understand the needs and challenges of a well-trained workforce and offer the right-mix of online education to ensure that the health care professionals are prepared to meet the challenges of the changing workplace.

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