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

Z04.42 is the ICD-10-CM diagnosis code for encounter for examination and observation following alleged child rape. A medical examination visit for a child who has reported being sexually assaulted, including assessment for injuries and collection of forensic evidence. Z04.42 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons encountering health services for examinations (z00-z13).

Z04.42 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Use this code for alleged child sexual abuse cases; coordinate with child protective services and law enforcement as appropriate.