2025 ICD-10-CM code Z40.03
(Active) Effective Date: N/A Revision Date: N/A Factors influencing health status and contact with health services - Encounters for other specific health care Chapter 21: Factors influencing health status and contact with health services Feed
Encounter for prophylactic removal of fallopian tube(s).
Modifiers may be applicable depending on the circumstances of the procedure and the payer requirements.Consult payer-specific guidelines for proper modifier usage.
Prophylactic bilateral salpingectomy is considered medically necessary when the risk of developing ovarian cancer or ectopic pregnancy significantly outweighs the risks associated with the surgery. This assessment should be based on a patient's individual risk factors, family history, and genetic predisposition.
The clinical responsibility for this code rests with the surgeon performing the prophylactic salpingectomy (removal of fallopian tubes). This includes pre-operative assessment, surgical technique, post-operative care, and follow-up.Other healthcare professionals, such as anesthesiologists and nurses, also play crucial roles in patient care.
- Chapter 21: 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 remove their fallopian tubes to prevent problems later on, such as an ectopic pregnancy (pregnancy outside the womb) or ovarian cancer. The surgery is planned and isn't done because of a current illness or injury.
This ICD-10-CM code classifies an encounter for the prophylactic (preventative) surgical removal of one or both fallopian tubes.The procedure is performed to reduce the risk of future conditions, such as ectopic pregnancy or ovarian cancer, and is not in response to a current illness or injury.This code is used when the removal is a planned preventative measure and is not part of a larger surgical procedure.
Example 1: A 35-year-old woman with a strong family history of ovarian cancer opts for a prophylactic bilateral salpingectomy to mitigate her risk.This procedure is performed as a preventative measure and not due to any current illness., A 40-year-old woman with BRCA gene mutation undergoes a prophylactic bilateral salpingectomy and oophorectomy (removal of ovaries) to significantly reduce her risk of ovarian and breast cancers. Z40.03 would be used to code the salpingectomy component specifically., A patient with a history of severe endometriosis, despite already undergoing treatment, chooses a prophylactic bilateral salpingectomy to minimize future complications like ectopic pregnancy and reduce the recurrence of endometriosis pain.
* Thorough patient history including family history of ovarian or breast cancer, genetic testing results (if applicable), and previous medical conditions.* Complete surgical report detailing the procedure performed, including the number of fallopian tubes removed and any complications encountered.* Documentation supporting the medical necessity for the procedure, especially in cases without a strong family history.This may include discussion of risk factors, alternatives, and benefits and risks discussed with the patient.* Post-operative progress notes confirming recovery and absence of complications.
** This code should only be used when the procedure is explicitly prophylactic.If the fallopian tubes are removed during another procedure (e.g., hysterectomy), code the specific procedure performed and not Z40.03.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gynecology, Oncology
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital