2027 ICD-10-CM Diagnosis Code Z04.42Encounter for examination and observation following alleged child rape

ICD-10-CM Codes›Z00–Z99›Z00-Z13›Z04

ICD-10-CM Z04.42
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

Z04.42 is a billable ICD-10-CM diagnosis code for encounter for examination and observation following alleged child rape. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is restricted by the Medicare Code Editor to pediatric patients (age 0 through 17). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Encounter for observation and examination for conditions ruled out (excludes infectious disease, neoplasm, mental disorders).

Code Identity

ICD-10-CM Code
Z04.42
Billable Status
Yes — Valid for Submission
Code Describes
Encounter for examination and observation following alleged child rape
Short Description
Encounter for exam and obs following alleged child rape
Parent Code
Z04.4
Encounter for examination and observation following alleged rape

Code Classification

ChapterZ00–Z99Factors influencing health status and contact with health services
SectionZ00-Z13Persons encountering health services for examinations
CategoryZ04Encounter for examination and observation for other reasons
This CodeZ04.42Encounter for examination and observation following alleged child rape

Code EditsBilling

Medicare Code Editor checks that affect claim validity for Z04.42.

Pediatric diagnoses
The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients age range is 0–17 years inclusive (e.g., Reye's syndrome, routine child health exam).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to Z04.42: its own notes plus those printed at Z04, block Z00-Z13, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From Z04 Encounter for examination and observation for other reasons applies to 12 codes
  • 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.

Applicable To

Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.

  • Suspected child rape, ruled out
  • Suspected child sexual abuse, ruled out

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Block Z00-Z13 Persons encountering health services for examinations applies to 156 codes
  • examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Notes

General instructions on how these codes are used.

From Block Z00-Z13 Persons encountering health services for examinations applies to 156 codes
  • Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.
From Chapter 21 (Z00-Z99) Factors influencing health status and contact with health services applies to 1,425 codes
  • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
  • (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
  • (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name Z04.42, its category, or a range that includes it.

Excludes1 2

These codes carry an Excludes1 note naming Z04.42: they are not reported together with it, unless the two conditions are unrelated.

  • T76 Adult and child abuse, neglect and other maltreatment, suspected
    suspected child sexual abuse, ruled out (Z04.42)
  • Z04.72 Encounter for examination and observation following alleged child physical abuse
    encounter for examination and observation following alleged child sexual abuse (Z04.42)

Excludes2 1

These codes carry an Excludes2 note naming Z04.42: its condition is not part of those codes, and both may be reported when the patient has both.

  • Z02.84 Encounter for child welfare exam
    encounter for examination and observation for alleged child rape (Z04.42)

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR FAC003
Encounter for observation and examination for conditions ruled out (excludes infectious disease, neoplasm, mental disorders)
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Child Sexual Abuse

Sexual abuse is one form of child abuse. It includes a wide range of actions between a child and an adult or older child. Often these involve body contact, but not always. Exposing one's genitals to children or pressuring them for sex is sexual abuse. Using a child for pornography is also sexual abuse.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert Z04.42 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
V71.5 Observ following rape
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About Z04.42Overview

What is the ICD-10 code for encounter for examination and observation following alleged child rape?

The ICD-10-CM code for encounter for examination and observation following alleged child rape is Z04.42 (sometimes written as Z0442). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is Z04.42 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report encounter for examination and observation following alleged child rape on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does Z04.42 group to?

When encounter for examination and observation following alleged child rape is the principal diagnosis on an inpatient stay, it groups to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.

Who can Z04.42 be reported for?

The Medicare Code Editor checks encounter for examination and observation following alleged child rape against patient demographics: this code is intended for pediatric patients (age 0 through 17). Claims outside these limits are flagged as inconsistent.

What is the ICD-9 equivalent of Z04.42?

Under the General Equivalence Mappings, encounter for examination and observation following alleged child rape converts to ICD-9-CM V71.5 (observ following rape). The mapping is approximate, so confirm the match fits the documentation.