2027 ICD-10-CM Diagnosis Code Z13.5Encounter for screening for eye and ear disorders
Z13.5 is a billable ICD-10-CM diagnosis code for encounter for screening for eye and ear disorders. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. Coders also document this condition as child hearing screening failure. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Encounter for observation and examination for conditions ruled out (excludes infectious disease, neoplasm, mental disorders).
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z13.5.
Present on Admission (POA)Billing
Z13.5 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons encountering health services for examinations (Z00-Z13).
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Child hearing screening failure
- Child hearing screening failure referred to specialist
- Child hearing screening first failure
- Child hearing screening second failure
- Hearing screening status
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z13.5: its own notes plus those printed at Z13, block Z00-Z13, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- encounter for diagnostic examination-code to sign or symptom
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z13.5, its category, or a range that includes it.
Excludes2 2
These codes carry an Excludes2 note naming Z13.5: its condition is not part of those codes, and both may be reported when the patient has both.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
cataract Z13.5
eye disorder Z13.5
glaucoma Z13.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Health Screening
Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z13.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z13.5Overview
What is the ICD-10 code for encounter for screening for eye and ear disorders?
The ICD-10-CM code for encounter for screening for eye and ear disorders is Z13.5 (sometimes written as Z135). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z13.5 (Encounter for screening for other diseases and disorders) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report encounter for screening for eye and ear disorders on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z13.5 group to?
On inpatient claims, encounter for screening for eye and ear disorders maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Can Z13.5 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because encounter for screening for eye and ear disorders describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Is Z13.5 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for encounter for screening for eye and ear disorders on inpatient claims. The code appears in the Persons encountering health services for examinations (Z00-Z13) range of the CMS exempt list.
