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v1.0.0
ICD-10 Guide
ICD-10 CodesZ31.5

Z31.5

Encounter for procreative genetic counseling

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

Code Description

ICD-10 Z31.5 is a billable code used to indicate a diagnosis of encounter for procreative genetic counseling.

Key Diagnostic Point:

Z31.5 is used to indicate an encounter for procreative genetic counseling, which is a specialized form of counseling aimed at individuals or couples who are considering having children and wish to understand the genetic risks associated with inherited conditions. This counseling can help address concerns about genetic disorders, family history, and the implications of genetic testing. Factors influencing health status include genetic predispositions, family medical history, and environmental factors. Social determinants such as socioeconomic status, access to healthcare, and education level can significantly impact an individual's decision-making process regarding family planning and genetic testing. Preventive care in this context involves assessing risks and providing information that can lead to informed reproductive choices, while screening may include genetic tests to identify potential hereditary conditions. Aftercare may involve follow-up counseling based on test results and further discussions about reproductive options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for thorough documentation of family history and genetic risks
  • Variability in patient understanding of genetic concepts
  • Potential for multiple follow-up visits based on counseling outcomes
  • Integration of social determinants of health into counseling

Audit Risk Factors

  • Inadequate documentation of family history or genetic risks
  • Failure to document the purpose of the counseling session
  • Misuse of the code for non-genetic counseling encounters
  • Lack of follow-up documentation if further counseling is needed

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, reasons for counseling, and any genetic tests discussed or ordered.

Common Clinical Scenarios

Patients seeking advice on family planning after a known genetic disorder in the family.

Billing Considerations

Consideration of social factors such as access to genetic testing and education about genetic risks.

Public Health

Documentation Requirements

Documentation should include population health data, risk factors identified, and community resources available.

Common Clinical Scenarios

Community outreach programs providing genetic counseling for at-risk populations.

Billing Considerations

Focus on health equity and access to genetic counseling services.

Coding Guidelines

Inclusion Criteria

Use Z31.5 When
  • Z codes are used when a patient encounters health services for reasons other than a current illness or injury
  • 5 should be sequenced appropriately, often as a primary diagnosis when the encounter is solely for genetic counseling
  • Payer requirements may vary, so it's essential to check specific insurance guidelines regarding coverage for genetic counseling services

Exclusion Criteria

Do NOT use Z31.5 When
No specific exclusions found.

Related CPT Codes

96040CPT Code

Genetic counseling, individual or family

Clinical Scenario

Used when a patient receives genetic counseling for hereditary conditions.

Documentation Requirements

Document the reason for counseling, family history, and any genetic tests discussed.

Specialty Considerations

Primary care providers should ensure they understand genetic counseling processes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding genetic counseling encounters, improving data collection and analysis of genetic health trends.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding genetic counseling encounters, improving data collection and analysis of genetic health trends.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding genetic counseling encounters, improving data collection and analysis of genetic health trends.

Resources

Clinical References

  • •
    Genetic Counseling Guidelines

Coding & Billing References

  • •
    Genetic Counseling Guidelines

Frequently Asked Questions

When should Z31.5 be used instead of other Z codes?

Z31.5 should be used specifically for encounters focused on procreative genetic counseling, particularly when discussing genetic risks and testing options. It should not be used for general health counseling or unrelated medical visits.