Question 1

What is ICD-10 code Z31.42?

Accepted Answer

Z31.42 is the ICD-10-CM diagnosis code for aftercare following sterilization reversal. Follow-up care after a surgical procedure to reverse sterilization, such as checking healing and fertility restoration. Z31.42 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons encountering health services in circumstances related to reproduction (z30-z39).

Z31.42 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Use this code for post-operative visits following sterilization reversal procedures.

Question 2

Is Z31.42 an HCC code?

Accepted Answer

No. Z31.42 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is Z31.42 billable?

Accepted Answer

Yes. Z31.42 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. Z31.42 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does Z31.42 map to under V28?

Accepted Answer

Z31.42 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does Z31.42 pay in RAF?

Accepted Answer

Z31.42 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for Z31.42?

Accepted Answer

Z31.42 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards Z31.42 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports Z31.42?

Accepted Answer

Use this code for post-operative visits following sterilization reversal procedures Ensure the sterilization reversal procedure has been previously documented and coded separately Z31.42 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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Z31.42

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Z31.42 ICD-10-CM Code: Aftercare following sterilization reversal

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Z31.42

Is Z31.42 an HCC code?

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