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2025 ICD-10-CM code Z30.2

Encounter for sterilization.

This code is a Z code and represents a reason for encounter.A procedure code must also be reported to describe the sterilization method performed. It cannot be a primary diagnosis if the encounter is for the treatment of a disease or injury.

Sterilization is considered medically necessary when requested by a competent adult who understands the permanence of the procedure.Specific payer requirements may vary.

The physician is responsible for performing the sterilization procedure, counseling the patient about the permanence of the procedure, obtaining informed consent, and ensuring appropriate post-operative care.

In simple words: This code indicates that the patient visited a healthcare facility to undergo a procedure to become permanently unable to have children.

This code is used to document an encounter for a sterilization procedure.Sterilization is a medical procedure that renders an individual permanently infertile. For women, this typically involves blocking or severing the fallopian tubes.For men, it involves severing the vas deferens (spermatic ducts) to prevent sperm from being transported.

Example 1: A 35-year-old female presents to the hospital for a laparoscopic tubal ligation., A 40-year-old male presents to the clinic for a vasectomy., A 28-year-old female with a history of multiple cesarean sections elects for sterilization during her current cesarean delivery.

Documentation should include the patient's informed consent, the specific sterilization procedure performed, operative details, and post-operative instructions.

** For Medicaid claims, Z30.2 must be included as either the primary or secondary diagnosis. As of November 30, 2024, this information is current.However, medical coding guidelines are subject to change, so it's essential to stay updated with the latest information.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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