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v1.0.0
ICD-10 Guide
ICD-10 CodesZ36.1

Z36.1

Encounter for antenatal screening for raised alphafetoprotein level

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

Code Description

ICD-10 Z36.1 is a billable code used to indicate a diagnosis of encounter for antenatal screening for raised alphafetoprotein level.

Key Diagnostic Point:

Z36.1 is used to indicate an encounter for antenatal screening specifically aimed at detecting elevated levels of alpha-fetoprotein (AFP) in pregnant individuals. Elevated AFP levels can be associated with various fetal conditions, including neural tube defects and chromosomal abnormalities. This screening is a crucial preventive measure in prenatal care, allowing for early detection and management of potential health issues. Social determinants of health, such as access to healthcare, socioeconomic status, and education, significantly influence the likelihood of receiving appropriate screening. Preventive care through regular antenatal visits ensures that expectant mothers are monitored for AFP levels, which can lead to timely interventions and improved maternal and fetal outcomes. The screening process involves counseling, education about the implications of results, and potential follow-up testing, emphasizing the importance of comprehensive care in the prenatal period.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate documentation of screening results and follow-up plans
  • Variability in patient understanding of screening importance
  • Potential for multiple follow-up codes based on screening outcomes
  • Integration of social determinants affecting screening access

Audit Risk Factors

  • Inadequate documentation of screening results
  • Failure to document follow-up actions or referrals
  • Lack of patient education records
  • Inconsistent coding of related conditions or follow-up visits

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include the reason for screening, results, and any follow-up plans or referrals.

Common Clinical Scenarios

Routine prenatal visits where AFP screening is discussed and performed.

Billing Considerations

Consideration of social determinants such as access to care and patient education on the importance of screening.

Public Health

Documentation Requirements

Data collection for population health management and tracking of screening rates.

Common Clinical Scenarios

Community health initiatives aimed at increasing awareness and access to prenatal screenings.

Billing Considerations

Focus on health disparities and outreach efforts to underserved populations.

Coding Guidelines

Inclusion Criteria

Use Z36.1 When
  • Z codes are used when a patient encounters a healthcare service for reasons other than a current illness or injury
  • 1 should be sequenced appropriately, often as a secondary code following a primary diagnosis related to pregnancy
  • Payer requirements may vary, so it is essential to verify coverage for screening services

Exclusion Criteria

Do NOT use Z36.1 When
No specific exclusions found.

Related CPT Codes

84155CPT Code

Alpha-fetoprotein (AFP) test

Clinical Scenario

Used during routine prenatal visits for screening purposes.

Documentation Requirements

Document the reason for the test, results, and any follow-up actions.

Specialty Considerations

Primary care providers should ensure comprehensive patient education regarding the implications of results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding antenatal screenings, including Z36.1, which helps in tracking health outcomes and improving preventive care measures.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding antenatal screenings, including Z36.1, which helps in tracking health outcomes and improving preventive care measures.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding antenatal screenings, including Z36.1, which helps in tracking health outcomes and improving preventive care measures.

Resources

Clinical References

  • •
    CDC Guidelines for Prenatal Care

Coding & Billing References

  • •
    CDC Guidelines for Prenatal Care

Frequently Asked Questions

What is the significance of elevated alpha-fetoprotein levels during pregnancy?

Elevated AFP levels can indicate potential fetal abnormalities, such as neural tube defects or chromosomal issues. It is crucial for healthcare providers to educate patients about the implications of these results and the importance of follow-up testing.