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v1.0.0
ICD-10 Guide
ICD-10 CodesZ13.7

Z13.7

Encounter for screening for genetic and chromosomal anomalies

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

Code Description

ICD-10 Z13.7 is a billable code used to indicate a diagnosis of encounter for screening for genetic and chromosomal anomalies.

Key Diagnostic Point:

Z13.7 is used for encounters specifically aimed at screening for genetic and chromosomal anomalies, which are critical in identifying potential hereditary conditions that may affect an individual's health. This screening is particularly relevant for individuals with a family history of genetic disorders, those who are pregnant, or couples planning to conceive. Social determinants of health, such as socioeconomic status, education, and access to healthcare, significantly influence the likelihood of undergoing such screenings. Preventive care through genetic screening can lead to early interventions, informed family planning, and tailored healthcare strategies, ultimately improving health outcomes. The importance of documentation cannot be overstated, as it must reflect the rationale for screening, any relevant family history, and the patient's informed consent. This code is essential in promoting awareness and proactive health management in diverse populations, particularly in primary care and public health settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for detailed family history documentation
  • Variability in payer coverage for genetic screenings
  • Potential for multiple genetic tests to be performed
  • Requirement for informed consent documentation

Audit Risk Factors

  • Inadequate documentation of family history
  • Failure to obtain informed consent
  • Coding without appropriate clinical indication
  • Misuse of the code for non-screening encounters

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include patient history, reason for screening, and any relevant family history of genetic disorders.

Common Clinical Scenarios

Routine checkups where genetic screening is discussed, referrals for genetic counseling, and follow-up appointments post-screening.

Billing Considerations

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

Public Health

Documentation Requirements

Documentation should reflect population-level data, screening outcomes, and follow-up actions taken based on screening results.

Common Clinical Scenarios

Community health initiatives promoting genetic screening, epidemiological studies on genetic disorders, and public health campaigns.

Billing Considerations

Focus on tracking health disparities and access to genetic screening services in various populations.

Coding Guidelines

Inclusion Criteria

Use Z13.7 When
  • Z codes are used when a patient is not currently ill but is seeking preventive services
  • 7 should be sequenced appropriately, often as a primary diagnosis when the encounter is solely for screening
  • Payer requirements may vary, so it is essential to verify coverage for genetic screenings

Exclusion Criteria

Do NOT use Z13.7 When
No specific exclusions found.

Related CPT Codes

81200CPT Code

BRCA1 and BRCA2 gene analysis

Clinical Scenario

Used in conjunction with Z13.7 for patients at risk of breast and ovarian cancer.

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 genetic testing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding genetic screenings, improving the ability to track and manage genetic health risks.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding genetic screenings, improving the ability to track and manage genetic health risks.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding genetic screenings, improving the ability to track and manage genetic health risks.

Resources

Clinical References

  • •
    Genetic Testing Guidelines

Coding & Billing References

  • •
    Genetic Testing Guidelines

Frequently Asked Questions

When should Z13.7 be used?

Z13.7 should be used when a patient is being screened for genetic and chromosomal anomalies, particularly when there is a family history or other risk factors present.