Is Z31.43 a billable ICD-10-CM code?

No. Z31.43 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does Z31.43 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons encountering health services in circumstances related to reproduction (Z30-Z39).

What cannot be coded together with Z31.43?

Z31.43 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Z31.43 (Z31.4) and apply to it just the same.

Z31.43

Z31.43 — Encounter for genetic testing of female for procreative management

Non-billable headerICD-10-CM

Z31.43 is a non-billable header ICD-10-CM code for encounter for genetic testing of female for procreative management. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

nonprocreative genetic testing (Z13.7-)

Use additional code

Add a secondary code to capture the detail described below.

code for recurrent pregnancy loss, if applicable (N96, O26.2-)

Excludes1 inherited from the categories above Z31.43

These are not written on Z31.43, but they bind it: a note on a category applies to every code beneath it. Billing Z31.43 with anything listed here is a denial.

Written on Z31.4 — Encounter for procreative investigation and testing

postvasectomy sperm count (Z30.8)

Excludes2 inherited from the categories above Z31.43

Also inherited, and the opposite of Excludes1: these conditions are not part of Z31.43, but a patient can have both, so you may code both.

Written on Z31 — Encounter for procreative management

complications associated with artificial fertilization (N98.-)
female infertility (N97.-)
male infertility (N46.-)

Risk adjustment

Z31.43 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

Z31.43 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead Z31.43

2 child codes. Green means billable.

Related codes at this level

Codes that share Z31.4. If Z31.43 is not quite right, the correct code is usually one of these.

Questions about Z31.43

Is Z31.43 a billable ICD-10-CM code?: No. Z31.43 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does Z31.43 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons encountering health services in circumstances related to reproduction (Z30-Z39).
What cannot be coded together with Z31.43?: Z31.43 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Z31.43 (Z31.4) and apply to it just the same.