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v1.0.0
ICD-10 Guide
ICD-10 CodesZ13.71

Z13.71

Encounter for nonprocreative screening for genetic disease carrier status

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

Code Description

ICD-10 Z13.71 is a billable code used to indicate a diagnosis of encounter for nonprocreative screening for genetic disease carrier status.

Key Diagnostic Point:

Z13.71 is used to indicate an encounter for screening to determine if an individual is a carrier of genetic diseases, which is crucial for preventive health measures and family planning. This screening is particularly relevant for individuals with a family history of genetic disorders or those belonging to ethnic groups with higher prevalence rates of certain genetic conditions. The social determinants of health, such as socioeconomic status, education, and access to healthcare, significantly influence the likelihood of individuals seeking this screening. Preventive care through genetic screening can lead to informed decision-making regarding family planning and potential interventions. The code is applicable in various healthcare settings, including primary care and genetic counseling, where healthcare providers assess risk factors and provide education on genetic conditions. Proper documentation is essential to support the medical necessity of the screening and to ensure accurate coding and billing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for detailed family history documentation
  • Understanding of genetic conditions and carrier status implications
  • Variability in payer requirements for coverage of genetic screening
  • Potential for overlapping diagnoses requiring careful differentiation

Audit Risk Factors

  • Inadequate documentation of family history
  • Failure to document informed consent for genetic testing
  • Coding without supporting clinical rationale
  • Misuse of the code for unrelated encounters

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document family history, risk factors, and patient education regarding genetic conditions.

Common Clinical Scenarios

Routine checkups where genetic screening is discussed, referrals for genetic counseling.

Billing Considerations

Consider social determinants such as access to genetic counseling services and patient education levels.

Public Health

Documentation Requirements

Population health data collection, tracking of genetic screening rates, and outcomes.

Common Clinical Scenarios

Community health initiatives aimed at increasing awareness of genetic disorders.

Billing Considerations

Focus on health disparities and access to genetic screening in underserved populations.

Coding Guidelines

Inclusion Criteria

Use Z13.71 When
  • Z codes are used to indicate encounters for reasons other than illness or injury
  • 71 should be sequenced appropriately, typically as a secondary diagnosis when a primary condition is being treated
  • Payer requirements may vary, so it is essential to verify coverage for genetic screening services

Exclusion Criteria

Do NOT use Z13.71 When
No specific exclusions found.

Related CPT Codes

81200CPT Code

BRCA1 and BRCA2 gene analysis

Clinical Scenario

Used in conjunction with Z13.71 for patients seeking carrier status screening for breast and ovarian cancer.

Documentation Requirements

Document the reason for testing, family history, and informed consent.

Specialty Considerations

Primary care providers should ensure patients understand the implications of testing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding genetic screening encounters, improving data collection and analysis for public health initiatives.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding genetic screening encounters, improving data collection and analysis for public health initiatives.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding genetic screening encounters, improving data collection and analysis for public health initiatives.

Resources

Clinical References

  • •
    Genetic Testing Guidelines

Coding & Billing References

  • •
    Genetic Testing Guidelines

Frequently Asked Questions

What is the importance of documenting family history for Z13.71?

Documenting family history is crucial for justifying the need for genetic screening. It helps establish the patient's risk level and supports the medical necessity of the encounter, ensuring proper coding and reimbursement.