Z04.42 vs Z04.72
Z04.42 (Encounter for examination and observation following alleged child rape) compared with Z04.72 (Encounter for examination and observation following alleged child physical abuse), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. Z04.72 carries an Excludes1 note covering Z04.42: “encounter for examination and observation following alleged child sexual abuse (Z04.42)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| Z04.42Encounter for examination and observation following alleged child rape | Z04.72Encounter for examination and observation following alleged child physical abuse | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) |
| Definition | Encounter for examination and observation following alleged child rape is a billable ICD-10-CM diagnosis code (Z04.42). | Encounter for examination and observation following alleged child physical abuse is a billable ICD-10-CM diagnosis code (Z04.72). |
| Includes | encounter for examination for medicolegal reasons This category is to be used when a person without a diagnosis is suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is ruled-out. This category is also for use for administrative and legal observation status. Suspected child rape, ruled out Suspected child sexual abuse, ruled out | encounter for examination for medicolegal reasons This category is to be used when a person without a diagnosis is suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is ruled-out. This category is also for use for administrative and legal observation status. Suspected child physical abuse, ruled out |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources