ICD-10 Guide

Z31.42

Aftercare following sterilization reversal

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z31.42 is a billable code used to indicate a diagnosis of aftercare following sterilization reversal.

Key Diagnostic Point:

Z31.42 is used to indicate aftercare following a sterilization reversal procedure. This code is relevant for patients who have undergone a surgical procedure to reverse a previous sterilization, such as a vasectomy or tubal ligation. The aftercare phase is crucial as it involves monitoring the patient's recovery, assessing the success of the procedure, and addressing any complications that may arise. Factors influencing health status include the patient's age, overall health, and psychological readiness for potential pregnancy. Social determinants such as access to healthcare, socioeconomic status, and support systems also play a significant role in the patient's health outcomes. Preventive care during this phase may include counseling on family planning and reproductive health, while screening may involve fertility assessments. Proper documentation of the patient's medical history, the procedure performed, and follow-up care is essential for accurate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Requires detailed documentation of the surgical procedure and aftercare plan.
Involves understanding of reproductive health and potential complications.
May require coordination with multiple specialties (e.g., urology, gynecology).
Documentation must reflect the patient's health status and social determinants.

Audit Risk Factors

Inadequate documentation of the procedure and aftercare.
Failure to link the Z code to the primary diagnosis appropriately.
Lack of evidence for the medical necessity of the reversal procedure.
Insufficient follow-up notes indicating patient progress or complications.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, procedure details, and follow-up care plans.

Common Clinical Scenarios

Routine checkups post-reversal, fertility assessments, and counseling on family planning.

Billing Considerations

Consideration of social determinants such as access to fertility treatments and support systems.

Public Health

Documentation Requirements

Population-level data on sterilization reversals and their outcomes.

Common Clinical Scenarios

Epidemiological studies on fertility trends and access to reproductive health services.

Billing Considerations

Tracking health disparities related to sterilization and reproductive health access.

Coding Guidelines

Inclusion Criteria

Use Z31.42 When

Z codes are used to indicate aftercare and should be sequenced appropriately following the primary diagnosis
Payer requirements may vary, so it is essential to verify coverage for aftercare services related to sterilization reversal
Documentation must support the medical necessity of the aftercare provided

Exclusion Criteria

Do NOT use Z31.42 When

No specific exclusions found.

Related CPT Codes

58661CPT Code

Laparoscopic tubal ligation reversal

Clinical Scenario

Used in conjunction with Z31.42 for aftercare following the procedure.

Documentation Requirements

Document the procedure performed and any follow-up care provided.

Specialty Considerations

Considerations for reproductive health counseling and follow-up.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity for aftercare codes, allowing for better tracking of patient outcomes and healthcare utilization related to sterilization reversals.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity for aftercare codes, allowing for better tracking of patient outcomes and healthcare utilization related to sterilization reversals.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

•
CDC Family Planning Guidelines

Coding & Billing References

•
CDC Family Planning Guidelines

Frequently Asked Questions

What documentation is required for Z31.42?

Documentation must include details of the sterilization reversal procedure, the patient's health status, any complications, and the aftercare plan. It should also address social determinants affecting the patient's health.

ICD-10 Z31.42 is a billable code used to indicate a diagnosis of aftercare following sterilization reversal.