2025 ICD-10-CM code Z40
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Encounter - Encounters for other specific health care Factors influencing health status and contact with health services Feed
Encounter for prophylactic surgery.
Modifiers may be applicable depending on the procedure performed and the specific circumstances of the encounter.
Medical necessity is established through documented high risk factors, strong family history of the disease the surgery is preventing, and/or the presence of genetic mutations increasing the probability of developing the disease.The necessity should be clearly justified in the clinical documentation.
The clinical responsibility involves the surgeon performing the prophylactic surgery and the entire surgical team.Pre-operative consultations, risk assessment, surgical planning, and post-operative care are all included in the clinical responsibility.
- Factors influencing health status and contact with health services
- Z40-Z53 (Encounters for other specific health care)
In simple words: This code is used when someone has surgery to prevent a disease from developing, not to treat one they already have.For example, if someone has surgery to remove their ovaries to reduce their risk of cancer, this code would be used.The doctor will also use a code to describe the actual surgery performed.
This ICD-10-CM code signifies an encounter for prophylactic surgery.It's used when a patient undergoes surgery to prevent a future disease or condition, rather than to treat an existing one.A corresponding procedure code must accompany Z40 if a procedure is performed.This code excludes organ donations (Z52.-) and therapeutic organ removal (code to the underlying condition).
Example 1: A 45-year-old woman with a strong family history of breast cancer undergoes a prophylactic bilateral mastectomy.Code Z40 would be used to describe the reason for the encounter, along with a procedure code for the mastectomy., A patient with a genetic predisposition to colon cancer undergoes a prophylactic colectomy. Z40 is used to capture the reason for the encounter, with an additional procedure code., A patient with Lynch syndrome undergoes a prophylactic hysterectomy and bilateral salpingo-oophorectomy.Z40 would be used, along with the appropriate procedural codes.
Detailed family history, genetic testing results (if applicable), physician's notes explaining the decision for prophylactic surgery, consent forms, operative reports, pathology reports, and post-operative care records.
** The selection of Z40 requires careful consideration, ensuring it accurately reflects the reason for the encounter.This code should only be used for prophylactic surgeries and not for therapeutic surgeries, even if performed for preventative reasons.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may be applicable depending on the procedure performed and the specific circumstances of the encounter.
- Specialties:Surgical Oncology, Genetics, General Surgery, Gynecology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient Department