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v1.0.0
ICD-10 Guide
ICD-10 CodesZ31.6

Z31.6

Encounter for general counseling and advice on procreation

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

Code Description

ICD-10 Z31.6 is a billable code used to indicate a diagnosis of encounter for general counseling and advice on procreation.

Key Diagnostic Point:

Z31.6 is used to document encounters where patients receive counseling and advice regarding procreation. This may include discussions about fertility, family planning, and reproductive health. Factors influencing health status, such as socioeconomic status, education, and access to healthcare services, play a critical role in these encounters. Preventive care is emphasized, as counseling can lead to informed decisions about reproductive health, potentially reducing risks associated with unintended pregnancies and enhancing overall family health. Screening for conditions that may affect procreation, such as genetic disorders or sexually transmitted infections, may also be part of these encounters. Understanding social determinants of health is essential, as they can significantly impact an individual's reproductive choices and access to necessary services.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of counseling provided
  • Variability in patient needs and circumstances
  • Potential overlap with other Z codes related to reproductive health
  • Importance of capturing social determinants affecting procreation

Audit Risk Factors

  • Inadequate documentation of counseling details
  • Failure to link Z31.6 with relevant clinical conditions
  • Misuse of Z31.6 when a specific diagnosis is present
  • Lack of clarity on the patient's reproductive goals

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include details of the counseling session, patient concerns, and any referrals made for further evaluation or treatment.

Common Clinical Scenarios

Routine checkups where reproductive health is discussed, family planning consultations, and follow-ups after fertility assessments.

Billing Considerations

Consideration of social determinants such as education level, income, and access to healthcare services that may influence reproductive choices.

Public Health

Documentation Requirements

Documentation should focus on population health data, trends in reproductive health, and community resources available for family planning.

Common Clinical Scenarios

Community health initiatives aimed at improving reproductive health outcomes, educational programs on family planning.

Billing Considerations

Emphasis on tracking health disparities and access to reproductive health services in various populations.

Coding Guidelines

Inclusion Criteria

Use Z31.6 When
  • Z codes are used when a patient encounters healthcare services for reasons other than a specific illness or injury
  • 6 should be sequenced appropriately, often as a secondary code when a primary diagnosis is present
  • Payer requirements may vary, so it's essential to verify coverage for counseling services

Exclusion Criteria

Do NOT use Z31.6 When
No specific exclusions found.

Related CPT Codes

99401CPT Code

Preventive counseling visit, individual

Clinical Scenario

Used during a counseling session for family planning and reproductive health.

Documentation Requirements

Document the topics discussed, patient concerns, and any referrals made.

Specialty Considerations

Primary care providers should ensure comprehensive documentation to support the use of Z31.6.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters related to procreation, enhancing the ability to capture the nuances of counseling and advice provided to patients.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters related to procreation, enhancing the ability to capture the nuances of counseling and advice provided to patients.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters related to procreation, enhancing the ability to capture the nuances of counseling and advice provided to patients.

Resources

Clinical References

  • •
    CDC Family Planning Guidelines

Coding & Billing References

  • •
    CDC Family Planning Guidelines

Frequently Asked Questions

When should Z31.6 be used?

Z31.6 should be used when a patient receives general counseling and advice on procreation, particularly in the absence of a specific diagnosis related to infertility or reproductive health issues.