2027 ICD-10-CM Diagnosis Code Z04.81Encounter for examination and observation of victim following forced sexual exploitation

ICD-10-CM Codes›Z00–Z99›Z00-Z13›Z04

ICD-10-CM Z04.81
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

Z04.81 is a billable ICD-10-CM diagnosis code for encounter for examination and observation of victim following forced sexual exploitation. 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 exempt from POA reporting. 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
Z04.81
Billable Status
Yes — Valid for Submission
Code Describes
Encounter for examination and observation of victim following forced sexual exploitation
Short Description
Enctr for exam and obs of victim fol forced sex exploitation
Parent Code
Z04.8
Encounter for examination and observation for other specified reasons

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 CodeZ04.81Encounter for examination and observation of victim following forced sexual exploitation

Present on Admission (POA)Billing

Z04.81 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons encountering health services for examinations (Z00-Z13).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to Z04.81: 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.

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.

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

Sexual Assault

Sexual assault is any kind of sexual activity, contact, or experience that happens without your consent. That means the sexual activity happens even though you don't agree to it.

The full article covers:

  • What is sexual assault?
  • What does sexual assault include?
  • What does "consent" mean?
  • Who commits sexual assault?
  • What are the possible health effects from sexual assault?
  • What can I do if I'm a victim of sexual assault?
  • Can sexual assault be prevented?

Read the full article at MedlinePlus

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

Code History & ChangesHistory

Replacement Z04.81 replaces the following previously assigned code(s):

  • Z04.8 - Encounter for examination and observation for oth reasons
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About Z04.81Overview

Is Z04.81 a billable code?

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

What MS-DRG does Z04.81 group to?

When encounter for examination and observation of victim following forced sexual exploitation 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.

Is Z04.81 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for encounter for examination and observation of victim following forced sexual exploitation on inpatient claims. The code appears in the Persons encountering health services for examinations (Z00-Z13) range of the CMS exempt list.