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v1.0.0
ICD-10 Guide
ICD-10 CodesZ31.49

Z31.49

Encounter for other procreative investigation and testing

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

Code Description

ICD-10 Z31.49 is a billable code used to indicate a diagnosis of encounter for other procreative investigation and testing.

Key Diagnostic Point:

Z31.49 is utilized during encounters for various procreative investigations and testing that do not fall under more specific categories. This code is relevant in contexts where patients are seeking assistance with fertility, reproductive health assessments, or other related inquiries that do not have a definitive diagnosis. Factors influencing health status, such as socioeconomic status, access to healthcare, and education, play a significant role in reproductive health. Preventive care in this context may include counseling on reproductive options, genetic testing, and screenings for reproductive health issues. Social determinants of health, such as living conditions, financial stability, and community resources, can significantly impact a patient's ability to access necessary testing and follow-up care. Proper documentation is essential to capture the complexity of these encounters, ensuring that all relevant factors influencing health status are noted.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying reasons for testing
  • Need for comprehensive documentation of patient history
  • Potential overlap with other Z codes related to reproductive health
  • Variability in payer requirements for coverage

Audit Risk Factors

  • Inadequate documentation of the reason for testing
  • Failure to link the Z code to relevant clinical findings
  • Misuse of the code for unrelated encounters
  • Lack of follow-up documentation for aftercare

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, reason for testing, and any relevant social determinants.

Common Clinical Scenarios

Routine fertility assessments, counseling on reproductive options, and follow-up visits.

Billing Considerations

Consideration of social factors such as access to care and financial stability.

Public Health

Documentation Requirements

Population health data collection, including demographics and health outcomes.

Common Clinical Scenarios

Community health screenings and educational outreach on reproductive health.

Billing Considerations

Focus on health disparities and access to reproductive health services.

Coding Guidelines

Inclusion Criteria

Use Z31.49 When
  • Z codes should be used when a patient encounters healthcare services for reasons other than a current illness or injury
  • Proper sequencing is crucial; Z31
  • 49 should be used as a secondary code when a primary diagnosis is present
  • Payer requirements may vary, so it is essential to verify coverage for specific testing

Exclusion Criteria

Do NOT use Z31.49 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used during a follow-up visit for procreative testing results.

Documentation Requirements

Document reason for visit, results discussion, and any further testing plans.

Specialty Considerations

Primary care providers should ensure comprehensive documentation of patient history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding procreative investigations, enabling better tracking of reproductive health issues and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding procreative investigations, enabling better tracking of reproductive health issues and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding procreative investigations, enabling better tracking of reproductive health issues and outcomes.

Resources

Clinical References

  • •
    CDC Reproductive Health Guidelines

Coding & Billing References

  • •
    CDC Reproductive Health Guidelines

Frequently Asked Questions

When should Z31.49 be used?

Z31.49 should be used during encounters for procreative investigations that do not fall under more specific categories, ensuring that the reason for the encounter is well-documented.