2024 ICD-10-CM Diagnosis Code Z31.438

Encounter for other genetic testing of female for procreative management

ICD-10-CM Code:
Z31.438
ICD-10 Code for:
Encounter for oth genetic testing of female for pro mgmt
Is Billable?
Yes - Valid for Submission
Code Navigator:

Code Classification

  • Factors influencing health status and contact with health services
    (Z00–Z99)
    • Persons encountering health services in circumstances related to reproduction
      (Z30-Z39)
      • Encounter for procreative management
        (Z31)

Z31.438 is a billable diagnosis code used to specify a medical diagnosis of encounter for other genetic testing of female for procreative management. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

This code is applicable to female patients only. It is clinically and virtually impossible to use this code on a non-female patient.

Clinical Classification

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

  • Diagnoses for females only - The Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, these edits apply to FEMALES only .
  • Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Present on Admission (POA)

Z31.438 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA IndicatorReason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z31.438 to ICD-9-CM

  • ICD-9-CM Code: V26.32 - Female genetic test NEC
    Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education


Genetic Testing

What is genetic testing?

Genetic testing is a type of medical test that looks for changes in your DNA. DNA is short for deoxyribonucleic acid. It contains the genetic instructions in all living things. Genetic tests analyze your cells or tissue to look for any changes in:

  • Genes, which are parts of DNA that carry the information needed to make a protein
  • Chromosomes, which are thread-like structures in your cells. They contain DNA and proteins.
  • Proteins, which do most of the work in your cells. Testing can look for changes in the amount and activity level of proteins. If it finds changes, it might be due to changes in your DNA.

Why is genetic testing done?

Genetic testing may be done for many different reasons, including to:

  • Find genetic diseases in unborn babies. This is one type of prenatal testing.
  • Screen newborn babies for certain treatable conditions
  • Lower the risk of genetic diseases in embryos that were created using assisted reproductive technology
  • Find out if you carry a gene for a certain disease that could be passed on to your children. This is called carrier testing.
  • See whether you are at increased risk of developing a specific disease. This may be done for a disease that runs in your family.
  • Diagnose certain diseases
  • Identify genetic changes that may be causing or contributing to a disease that you were already diagnosed with
  • Figure out how severe a disease is
  • Help guide your doctor in deciding the best medicine and dosage for you. This is called pharmacogenomic testing.

How is genetic testing done?

Genetic tests are often done on a blood or cheek swab sample. But they may also be done on samples of hair, saliva, skin, amniotic fluid (the fluid that surrounds a fetus during pregnancy), or other tissue. The sample is sent to a laboratory. There, a lab technician will use one of several different techniques to look for genetic changes.

What are the benefits of genetic testing?

The benefits of genetic testing include:

  • Helping doctors make recommendations for treatment or monitoring
  • Giving you more information for making decisions about your health and your family's health:
    • If you find out that you are at risk for a certain disease, you might take steps to lower that risk. For example, you may find out that you should be screened for a disease earlier and more often. Or you might decide to make healthy lifestyle changes.
    • If you find out that you are not at risk for a certain disease, then you can skip unnecessary checkups or screenings
    • A test could give you information that helps you make decisions about having children
  • Identifying genetic disorders early in life so treatment can be started as soon as possible

What are the drawbacks of genetic testing?

The physical risks of the different types of genetic testing are small. But there can be emotional, social, or financial drawbacks:

  • Depending on the results, you may feel angry, depressed, anxious, or guilty. This can be especially true if you are diagnosed with a disease that does not have effective treatments.
  • You may be worried about genetic discrimination in employment or insurance
  • Genetic testing may give you limited information about a genetic disease. For example, it cannot tell you whether you will have symptoms, how severe a disease might be, or whether a disease will get worse over time.
  • Some genetic tests are expensive, and health insurance might only cover part of the cost. Or they may not cover it at all.

How do I decide whether to be tested?

The decision about whether to have genetic testing is complex. In addition to discussing the test with your health care provider, you can meet with a genetic counselor. Genetic counselors have specialized degrees and experience in genetics and counseling. They can help you understand the tests and weigh the risks and benefits. If you do get a test, they can explain the results and make sure that you have the support that you need.


[Learn More in MedlinePlus]

Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.