ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 Z48.816

Billable / Specific

Encounter for surgical aftercare following surgery on the genitourinary system

Z48
Block
0
Synonyms
6
LCDs
1
Payer Policies
0
Linked CPTs

About ICD-10-CM Z48.816

ICD-10-CM code Z48.816 represents Encounter for surgical aftercare following surgery on the genitourinary system. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z48). The 2026 edition of ICD-10-CM Z48.816 became effective on October 1, 2025.

Type 1 Excludes

Pure excludes, these codes can never be coded together with Z48.816. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • encounter for aftercare following sterilization reversal (Z31.42)

Medicare LCD Coverage for Z48.816

Local Coverage Determinations (LCDs) from CMS MACs that list Z48.816 as a covered diagnosis.

6 LCDs

Showing top 6. Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT Q5136 →
CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT Q5159 →
CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT Q5157 →
CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT J3590 →
CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT Q5158 →
CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Article ID: 52399, Effective: 2026-03-01 00:00:00, 409 covered, 0 non-covered
CPT J0897 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Z48.816.

1 policies

1 Medicare

Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Policy ID: ART-52399

CPT Codes Commonly Billed with Z48.816

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for Z48.816

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert Z48.816 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
Z48.816 V5876 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To Z48.816

Other codes in section Z40-Z53 (Encounters for other specific health care).

ICD-10 Z48.816, Billing FAQ

Is ICD-10 code Z48.816 billable? +

Yes, Z48.816 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for Z48.816? +

Type 1 Excludes (never code together with Z48.816): encounter for aftercare following sterilization reversal (Z31.42)

What ICD-9 codes does Z48.816 map to? +

Per CMS GEMs, Z48.816 maps to ICD-9 codes: V5876. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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