Coding and coverage · ICD-10-CM

Z31 › Z31.4 › Z31.43

Z31.438 Encounter for other genetic testing of female for procreative management

BillableNo payment HCCChapter 21

Instructional notes

Chapter 21

Notes
  • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
  • (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
  • (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Z31

Excludes2Not included here: the patient may have both; report both when both are present.
  • complications associated with artificial fertilization (N98.-)
  • female infertility (N97.-)
  • male infertility (N46.-)

Z31.4

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • postvasectomy sperm count (Z30.8)

Z31.43

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • nonprocreative genetic testing (Z13.7-)
Use additional codeAdd a second code for the full picture.
  • code for recurrent pregnancy loss, if applicable (N96, O26.2-)

Chapter 21: Factors influencing health status and contact with health services · Z30-Z39 Persons encountering health services in circumstances related to reproduction (Z30-Z39)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.