2026 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 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

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 2026 (October 1, 2025 through September 30, 2026). 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).

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

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

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Examination(for) (following) (general) (of) (routine)
      • alleged rape or sexual assault (victim), ruled out
        • child
    • Observation(following) (for) (without need for further medical care)
      • alleged rape or sexual assault (victim), ruled out
        • child
    • Rape
      • alleged, observation or examination, ruled out
        • child

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 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About Z04.42Overview

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, 2025 through September 30, 2026.

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.