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ICD-10 Guide
ICD-10 CodesZ31.43

Z31.43

Encounter for genetic testing of female for procreative management

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

Code Description

ICD-10 Z31.43 is a billable code used to indicate a diagnosis of encounter for genetic testing of female for procreative management.

Key Diagnostic Point:

Z31.43 is used to document encounters for genetic testing specifically aimed at procreative management in females. This testing is crucial for assessing genetic risks that may affect reproductive health, including hereditary conditions that could impact offspring. The decision to undergo genetic testing often involves various social determinants of health, such as socioeconomic status, education, and access to healthcare services. Preventive care is emphasized, as genetic testing can lead to informed reproductive choices, early interventions, and tailored healthcare plans. Screening for genetic conditions can also help identify individuals at risk for certain diseases, allowing for proactive management. Documentation must reflect the reason for testing, the patient's family history, and any counseling provided, ensuring a comprehensive understanding of the patient's health status and needs.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for detailed family history documentation
  • Understanding of genetic testing implications
  • Integration of social determinants of health
  • Potential for multiple related diagnoses

Audit Risk Factors

  • Inadequate documentation of family history
  • Failure to link genetic testing to specific health concerns
  • Misuse of Z codes without appropriate clinical context
  • Lack of patient consent documentation for testing

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, reasons for testing, and any counseling provided. Preventive measures and follow-up plans must be clearly outlined.

Common Clinical Scenarios

Routine checkups where genetic risks are assessed, referrals for genetic testing based on family history, and discussions about reproductive options.

Billing Considerations

Consideration of social determinants such as access to genetic counseling services and education about genetic risks.

Public Health

Documentation Requirements

Documentation should focus on population health data, including prevalence of genetic conditions and access to testing services.

Common Clinical Scenarios

Community health screenings for genetic conditions, public health initiatives to raise awareness about genetic testing.

Billing Considerations

Tracking health disparities related to genetic testing access and outcomes.

Coding Guidelines

Inclusion Criteria

Use Z31.43 When
  • Z codes are used to indicate encounters for reasons other than illness or injury
  • 43 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 genetic testing

Exclusion Criteria

Do NOT use Z31.43 When
No specific exclusions found.

Related CPT Codes

81200CPT Code

BRCA1 and BRCA2 gene analysis

Clinical Scenario

Used in conjunction with Z31.43 for patients undergoing genetic testing for breast and ovarian cancer risk.

Documentation Requirements

Documentation must include family history and the reason for testing.

Specialty Considerations

Primary care providers should ensure that patients understand the implications of test results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding for genetic testing, allowing for better tracking of genetic conditions and their implications for health management.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding for genetic testing, allowing for better tracking of genetic conditions and their implications for health management.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding for genetic testing, allowing for better tracking of genetic conditions and their implications for health management.

Resources

Clinical References

  • •
    Genetic Testing Guidelines

Coding & Billing References

  • •
    Genetic Testing Guidelines

Frequently Asked Questions

When should Z31.43 be used?

Z31.43 should be used when a female patient undergoes genetic testing specifically for procreative management, and the documentation must support the medical necessity of the testing.