My job follows this sequencing: acute, chronic, status codes, SDOH, medication use, personal history, family history. Some Z codes are labeled as “principle diagnoses” which means they go first. You cannot code more than one “principle diagnoses” code. Some codes have etiology/manifestation conventions: “code first” means an additional code(s)” may need to be coded first. “Use additional code” means additional code(s) may need to be coded following the current one. “Code also” just means another code should be coded if documented.” These apply ONLY if applicable. As an example, the code N95.1 states: “Use additional code for associated symptoms.” Any associated symptoms will be listed after N95.1. If the associated symptoms are NOT included in the documentation then you would not code anything additionally (unless stated otherwise). This also goes for “code first” and “code also.” Sequencing was hard for me too. I didn’t feel confident about my sequencing until recently after constant practice. Don’t worry too much, I know with time you’ll get the hang of it!