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v1.0.0
ICD-10 Guide
ICD-10 CodesZ31.438

Z31.438

Encounter for other genetic testing of female for procreative management

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

Code Description

ICD-10 Z31.438 is a billable code used to indicate a diagnosis of encounter for other genetic testing of female for procreative management.

Key Diagnostic Point:

Z31.438 is used for encounters where a female undergoes genetic testing aimed at procreative management, which may include assessing genetic risks for inherited conditions, carrier status for genetic disorders, or evaluating the genetic health of potential offspring. This code is relevant in contexts where social determinants of health, such as family history, socioeconomic status, and access to healthcare, influence reproductive choices. Preventive care through genetic testing can help identify risks early, allowing for informed decision-making regarding family planning and reproductive health. Screening for genetic conditions can also lead to early interventions and management strategies that improve health outcomes for both the mother and child.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of genetic tests available and their specific indications
  • Need for comprehensive family history documentation
  • Potential for multiple genetic conditions to be tested simultaneously
  • Variability in payer coverage for genetic testing

Audit Risk Factors

  • Inadequate documentation of medical necessity for genetic testing
  • Failure to specify the type of genetic test performed
  • Lack of family history information in the medical record
  • Improper sequencing of Z codes with primary diagnoses

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include the reason for genetic testing, family history, and any counseling provided regarding results.

Common Clinical Scenarios

Routine checkups where genetic testing is discussed, referrals for genetic counseling, and follow-up after test results.

Billing Considerations

Consideration of social determinants such as access to genetic counseling services and the patient's understanding of genetic risks.

Public Health

Documentation Requirements

Documentation should include population-level data on genetic testing trends and outcomes.

Common Clinical Scenarios

Community health initiatives promoting genetic testing for at-risk populations and surveillance of genetic conditions.

Billing Considerations

Focus on health equity and access to genetic testing resources in underserved communities.

Coding Guidelines

Inclusion Criteria

Use Z31.438 When
  • Z codes are used to indicate encounters for reasons other than illness or injury
  • When coding Z31
  • 438, ensure that it is sequenced appropriately with any primary diagnosis
  • Payer requirements may vary, so confirm coverage for genetic testing before coding
  • Documentation must support the medical necessity of the encounter

Exclusion Criteria

Do NOT use Z31.438 When
No specific exclusions found.

Related CPT Codes

81200CPT Code

Genetic testing for cystic fibrosis

Clinical Scenario

Used when a patient is tested for cystic fibrosis carrier status as part of procreative management.

Documentation Requirements

Documentation must include the reason for testing and family history.

Specialty Considerations

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity for genetic testing codes, allowing for better tracking of genetic conditions and their management. This specificity aids in research and public health initiatives.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity for genetic testing codes, allowing for better tracking of genetic conditions and their management. This specificity aids in research and public health initiatives.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity for genetic testing codes, allowing for better tracking of genetic conditions and their management. This specificity aids in research and public health initiatives.

Resources

Clinical References

  • •
    Genetic Testing Guidelines

Coding & Billing References

  • •
    Genetic Testing Guidelines

Frequently Asked Questions

What documentation is required for Z31.438?

Documentation must include the specific genetic tests performed, the medical necessity for testing, family history, and any counseling provided regarding the implications of the results.