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ICD-10 Guide
ICD-10 CodesZ11.3

Z11.3

Encounter for screening for infections with a predominantly sexual mode of transmission

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z11.3 is a billable code used to indicate a diagnosis of encounter for screening for infections with a predominantly sexual mode of transmission.

Key Diagnostic Point:

Z11.3 is used to indicate an encounter for screening for infections that are primarily transmitted through sexual contact, such as sexually transmitted infections (STIs) including HIV, syphilis, gonorrhea, and chlamydia. This code is crucial in preventive healthcare as it emphasizes the importance of early detection and management of STIs, which can significantly impact individual and public health. Factors influencing health status, such as socioeconomic status, access to healthcare, and education about sexual health, play a vital role in the effectiveness of screening programs. The code is often utilized in various healthcare settings, including primary care, sexual health clinics, and public health departments, to promote preventive care and reduce the incidence of STIs. Proper documentation is essential to support the use of this code, including patient history, risk factors, and the rationale for screening, which can help address social determinants of health and improve health outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive patient history and risk assessment.
  • Variability in screening guidelines based on age, gender, and risk factors.
  • Documentation of informed consent and patient education.
  • Potential for co-morbid conditions requiring additional coding.

Audit Risk Factors

  • Inadequate documentation of patient risk factors.
  • Failure to document informed consent for screening.
  • Lack of follow-up documentation for positive screening results.
  • Incorrect sequencing of codes related to STIs.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, risk factors, and rationale for screening. Include any counseling provided.

Common Clinical Scenarios

Routine checkups where sexual health is assessed, screenings for high-risk populations, and follow-up visits for abnormal results.

Billing Considerations

Consider social determinants such as access to healthcare, education on sexual health, and cultural factors influencing patient willingness to be screened.

Public Health

Documentation Requirements

Population-level data collection, surveillance of STI trends, and documentation of outreach efforts.

Common Clinical Scenarios

Community health screenings, epidemiological studies, and public health campaigns targeting high-risk populations.

Billing Considerations

Focus on health equity and addressing barriers to access for underserved populations.

Coding Guidelines

Inclusion Criteria

Use Z11.3 When
  • Z codes are used when a patient is not currently ill but is seeking preventive care or screening
  • 3 should be sequenced appropriately, often as a primary diagnosis when the encounter is solely for screening
  • Payer requirements may vary, so it is essential to verify coverage for STI screenings

Exclusion Criteria

Do NOT use Z11.3 When
No specific exclusions found.

Related CPT Codes

87110CPT Code

Chlamydia and gonorrhea testing

Clinical Scenario

Used in conjunction with Z11.3 when testing for STIs during a screening encounter.

Documentation Requirements

Document the reason for testing, patient consent, and any counseling provided.

Specialty Considerations

Primary care providers should ensure comprehensive sexual health education is provided.

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 initiatives related to STIs.

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 initiatives related to STIs.

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 initiatives related to STIs.

Resources

Clinical References

  • •
    CDC STI Screening Guidelines

Coding & Billing References

  • •
    CDC STI Screening Guidelines

Frequently Asked Questions

What are the key factors to consider when coding Z11.3?

Key factors include understanding the patient's risk factors, ensuring proper documentation of the screening rationale, and being aware of local screening guidelines. It's also important to consider social determinants of health that may affect access to screening.