ICD-10 Guide

Z15.04

Genetic susceptibility to malignant neoplasm of endometrium

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z15.04 is a billable code used to indicate a diagnosis of genetic susceptibility to malignant neoplasm of endometrium.

Key Diagnostic Point:

Z15.04 indicates a genetic predisposition to endometrial cancer, often linked to hereditary syndromes such as Lynch syndrome. Patients with this code may have a family history of endometrial or other related cancers, necessitating tailored preventive measures and screenings. Social determinants of health, such as access to genetic counseling, socioeconomic status, and education, significantly influence health outcomes for these patients. Preventive care includes regular gynecological exams, transvaginal ultrasounds, and endometrial biopsies as appropriate. Screening for endometrial cancer is crucial for early detection, especially in high-risk populations. Aftercare may involve monitoring for recurrence and managing any psychological impacts of genetic predisposition. Accurate documentation of family history, genetic testing results, and preventive measures taken is essential for proper coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Requires detailed family history documentation
Involves understanding of genetic syndromes
May necessitate coordination with genetic counselors
Potential for multiple related diagnoses

Audit Risk Factors

Inadequate documentation of family history
Failure to link genetic predisposition to preventive measures
Misuse of the code without confirmed genetic testing
Lack of follow-up documentation for screenings

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document family history, genetic counseling referrals, and preventive screenings.

Common Clinical Scenarios

Routine checkups where family history is assessed, screenings for endometrial cancer, and follow-up visits post-genetic testing.

Billing Considerations

Consider social determinants such as access to care and education on genetic risks.

Public Health

Documentation Requirements

Population health data on genetic predispositions and cancer incidence.

Common Clinical Scenarios

Community health screenings and educational programs on genetic risks.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use Z15.04 When

Z codes are used to indicate factors influencing health status and contact with health services
04 should be used when there is a confirmed genetic predisposition to endometrial cancer
It is important to sequence this code appropriately, often following a primary diagnosis of a related condition
Payer requirements may vary, so it is essential to check specific guidelines

Exclusion Criteria

Do NOT use Z15.04 When

No specific exclusions found.

Related CPT Codes

88141CPT Code

Cytopathology, cervical or vaginal, collected in a liquid-based medium

Clinical Scenario

Used during routine screenings for women with genetic predisposition.

Documentation Requirements

Document the reason for screening based on genetic risk.

Specialty Considerations

Primary care providers should ensure comprehensive family history is included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enhancing the ability to track and manage at-risk populations effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enhancing the ability to track and manage at-risk populations effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enhancing the ability to track and manage at-risk populations effectively.

Resources

Clinical References

•
National Comprehensive Cancer Network Guidelines

Coding & Billing References

•
National Comprehensive Cancer Network Guidelines

Frequently Asked Questions

When should Z15.04 be used?

Z15.04 should be used when a patient has a confirmed genetic predisposition to endometrial cancer, supported by family history and genetic testing results. It is essential to document any preventive measures taken as a result of this diagnosis.

ICD-10 Z15.04 is a billable code used to indicate a diagnosis of genetic susceptibility to malignant neoplasm of endometrium.