2025 ICD-10-CM code Z96.0
Presence of urogenital implants.
Medical necessity for the encounter must be supported by the documentation of the primary reason for the visit.The presence of the implant itself does not justify the visit.
The provider is responsible for documenting the presence and type of urogenital implant, and selecting the appropriate ICD-10-CM code.
In simple words: This code signifies that the patient has a urogenital implant.
Presence of urogenital implants. This code indicates the presence of a functional implant in the urogenital system.It excludes complications of internal prosthetic devices, implants, and grafts (T82-T85) and fitting and adjustment of prosthetic and other devices (Z44-Z46).
Example 1: A patient with a history of stress urinary incontinence presents for a follow-up appointment. She has a previously placed urethral sling. The Z96.0 code is used to indicate the presence of the urogenital implant (urethral sling)., A male patient presents with erectile dysfunction.He has a penile implant. The Z96.0 code is used to document the presence of this urogenital implant., A female patient is seen for a routine gynecological exam.She has a previously inserted vaginal pessary. Z96.0 would be used to document the presence of this implant.
Documentation should clearly specify the type of urogenital implant present. The medical record should also reflect the reason for the encounter, as Z codes are typically used to indicate a reason for the encounter and should be accompanied by a procedure code if a procedure is performed.
** It is important to distinguish between the presence of the implant (Z96.0) and any complications or revisions related to the implant, which would be coded separately.
- Specialties:Urology, Gynecology, General Surgery
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Office, Outpatient Hospital