Personal history of sex reassignment

This code indicates that a patient has undergone a medical and/or surgical process to align their physical characteristics with their gender identity, which differs from their sex assigned at birth. It signifies a completed transition or a history of such a transition, rather than an active process or a current diagnosis of gender dysphoria.

Apply this code when documenting a patient's past medical history of having undergone gender-affirming surgery or other medical interventions for sex reassignment. This is particularly relevant for ongoing care where the patient's transitioned status is pertinent to their current health management, but they are not actively undergoing the reassignment process.

• Do not use this code for active gender dysphoria or if the patient is currently undergoing gender-affirming procedures.
• This code is for historical documentation; it does not represent a current mental health diagnosis.
• Consider sequencing with other relevant codes that describe current conditions or reasons for the encounter.