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ICD-10 Guide
ICD-10 CodesZ31.69

Z31.69

Encounter for other general counseling and advice on procreation

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

Code Description

ICD-10 Z31.69 is a billable code used to indicate a diagnosis of encounter for other general counseling and advice on procreation.

Key Diagnostic Point:

Z31.69 is utilized during encounters where patients receive counseling and advice regarding procreation that does not fall under more specific categories. This may include discussions about fertility awareness, family planning, and reproductive health education. Factors influencing health status such as socioeconomic status, education, and access to healthcare services play a significant 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 improving maternal and child health outcomes. Screening for reproductive health issues may also be part of these encounters, ensuring that patients are aware of their health status and any necessary follow-up care. Social determinants of health, such as cultural beliefs and community resources, are critical in shaping the effectiveness of counseling provided during these encounters.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of counseling topics covered under this code
  • Need for thorough documentation of patient interactions
  • Potential overlap with other Z codes related to reproductive health
  • Variability in payer requirements for coverage

Audit Risk Factors

  • Inadequate documentation of counseling topics discussed
  • Failure to link counseling to specific health outcomes
  • Misuse of Z31.69 when a more specific Z code is applicable
  • Lack of evidence for the necessity of the encounter

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include details of the counseling session, topics discussed, and any referrals made. Preventive measures and patient education materials provided should also be noted.

Common Clinical Scenarios

Routine checkups where reproductive health is discussed, family planning consultations, and follow-up visits after initial counseling.

Billing Considerations

Consideration of social determinants such as access to contraception and cultural beliefs about family planning.

Public Health

Documentation Requirements

Documentation should focus on population-level data, including demographics of patients receiving counseling and outcomes of interventions.

Common Clinical Scenarios

Community health initiatives aimed at improving reproductive health awareness and access to services.

Billing Considerations

Tracking health status and outcomes in specific populations to inform public health strategies.

Coding Guidelines

Inclusion Criteria

Use Z31.69 When
  • Z codes should be used when a patient encounters health services for reasons other than a specific illness or injury
  • 69 should be sequenced appropriately, often as a secondary code following a primary diagnosis related to reproductive health
  • Payer requirements may vary, so it is essential to verify coverage for counseling services

Exclusion Criteria

Do NOT use Z31.69 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

Documentation of the counseling topics discussed and any educational materials provided.

Specialty Considerations

Primary care providers should ensure that preventive counseling aligns with patient needs.

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 counseling and procreation, enhancing the ability to capture the nuances of patient interactions.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    CDC Family Planning Resources

Coding & Billing References

  • •
    CDC Family Planning Resources

Frequently Asked Questions

What types of counseling are covered under Z31.69?

Z31.69 covers a wide range of counseling topics related to procreation, including family planning, fertility awareness, and reproductive health education. It is essential to document the specific topics discussed during the encounter to support the use of this code.