2025 ICD-10-CM code Z31.43
Encounter for genetic testing of a female for procreative management.
The genetic testing must be medically necessary for procreative management, meaning it is essential for making informed decisions about family planning and reproductive health. Testing for general health or unrelated reasons is not covered by this code.
- Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
- Persons encountering health services in circumstances related to reproduction (Z30-Z3A)
In simple words: This code is used when a woman visits a healthcare provider for genetic testing related to family planning or reproductive health.
This code is used for encounters with the healthcare system for genetic testing of a female specifically related to procreative management. This includes genetic testing done for purposes of family planning and reproductive health. Use additional code for recurrent pregnancy loss, if applicable (N96, O26.2-).
Example 1: A 32-year-old female with a family history of cystic fibrosis seeks genetic testing to determine her carrier status before attempting to conceive., A 28-year-old woman who has experienced recurrent pregnancy loss undergoes genetic testing to identify potential causes., A couple is undergoing in vitro fertilization and the female partner undergoes genetic testing as part of the process to assess the risk of passing on genetic disorders to the offspring.
Documentation should support the medical necessity of the genetic testing specifically for procreative management. This may include family history of genetic disorders, personal history of recurrent pregnancy loss, or other relevant clinical factors. The reason for testing and the relationship to reproductive health must be clearly documented.
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