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v1.0.0
ICD-10 Guide
ICD-10 CodesZ31.4

Z31.4

Encounter for procreative investigation and testing

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

Code Description

ICD-10 Z31.4 is a billable code used to indicate a diagnosis of encounter for procreative investigation and testing.

Key Diagnostic Point:

Z31.4 is used to classify encounters for procreative investigation and testing, which may include assessments of fertility, reproductive health, and genetic testing. This code is relevant in contexts where individuals or couples are seeking assistance with conception or understanding reproductive health issues. Factors influencing health status, such as age, lifestyle, and environmental factors, play a significant role in reproductive health. Social determinants, including access to healthcare, socioeconomic status, and education, can impact the likelihood of seeking procreative testing. Preventive care in this context may involve counseling on reproductive health, screenings for sexually transmitted infections, and genetic counseling. Proper documentation is essential to capture the reasons for the encounter, any previous fertility treatments, and relevant medical history, ensuring accurate coding and appropriate care pathways.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of reasons for testing (e.g., infertility, genetic concerns)
  • Need for detailed patient history and documentation
  • Potential for co-existing conditions affecting reproductive health
  • Variability in payer requirements for coverage of testing

Audit Risk Factors

  • Inadequate documentation of medical necessity for testing
  • Failure to link Z31.4 with appropriate CPT codes
  • Misclassification of encounters as routine rather than investigative
  • Lack of follow-up documentation for aftercare

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, reasons for testing, and any referrals made.

Common Clinical Scenarios

Patients presenting for fertility assessments, preconception counseling, or follow-up after infertility treatments.

Billing Considerations

Consider social determinants such as access to care, education on reproductive health, and support systems.

Public Health

Documentation Requirements

Collect data on population health trends, access to reproductive health services, and outcomes of testing.

Common Clinical Scenarios

Community health initiatives focusing on reproductive health education and access to testing.

Billing Considerations

Monitor health disparities and access issues related to reproductive health services.

Coding Guidelines

Inclusion Criteria

Use Z31.4 When
  • Z codes should be used when the encounter is for a specific reason related to health status rather than for a definitive diagnosis
  • 4 should be sequenced appropriately, often as a secondary code following a primary diagnosis related to reproductive health
  • Payer requirements may vary, so it is essential to verify coverage for specific tests

Exclusion Criteria

Do NOT use Z31.4 When
No specific exclusions found.

Related CPT Codes

89250CPT Code

Semen analysis

Clinical Scenario

Used in conjunction with Z31.4 when testing male fertility.

Documentation Requirements

Document the reason for the analysis and any previous fertility assessments.

Specialty Considerations

Primary care providers should ensure referrals are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding procreative investigations, allowing for better tracking of reproductive health issues and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding procreative investigations, allowing for better tracking of reproductive health issues and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding procreative investigations, allowing for better tracking of reproductive health issues and outcomes.

Resources

Clinical References

  • •
    CDC Reproductive Health Guidelines

Coding & Billing References

  • •
    CDC Reproductive Health Guidelines

Frequently Asked Questions

When should Z31.4 be used instead of a specific diagnosis code?

Z31.4 should be used when the encounter is specifically for procreative investigation and testing, rather than for a definitive diagnosis. It is essential to document the reasons for the encounter clearly.