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v1.0.0
ICD-10 Guide
ICD-10 CodesZ02.2

Z02.2

Encounter for examination for admission to residential institution

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z02.2 is a billable code used to indicate a diagnosis of encounter for examination for admission to residential institution.

Key Diagnostic Point:

Z02.2 is used to document encounters for examinations required prior to admission to a residential institution, such as a nursing home, rehabilitation facility, or long-term care facility. This examination often assesses the individual's physical and mental health status, ensuring they meet the necessary criteria for admission. Factors influencing health status, such as social determinants of health (e.g., socioeconomic status, living conditions, and access to healthcare), play a crucial role in determining the need for residential care. Preventive care measures, including vaccinations and screenings, may also be addressed during this encounter. Proper documentation is essential to capture the patient's health status and any relevant social factors that may impact their care and admission process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive documentation of health status and social determinants
  • Potential for varying institutional admission criteria
  • Involvement of multiple healthcare providers in the examination process
  • Requirement for detailed clinical history and physical examination findings

Audit Risk Factors

  • Inadequate documentation of the examination findings
  • Failure to capture relevant social determinants impacting health
  • Misuse of Z02.2 when a primary diagnosis is present
  • Lack of clarity on the purpose of the encounter in the medical record

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include a comprehensive health assessment, including physical and mental health evaluations, and any relevant social factors.

Common Clinical Scenarios

Routine checkups for patients being evaluated for admission to long-term care facilities, including assessments for chronic conditions.

Billing Considerations

Consideration of social determinants such as living conditions, caregiver availability, and community resources.

Public Health

Documentation Requirements

Documentation should include population health data, assessments of community resources, and tracking of health outcomes related to residential admissions.

Common Clinical Scenarios

Epidemiological studies assessing the health status of populations entering residential care.

Billing Considerations

Focus on health disparities and access to care in different populations.

Coding Guidelines

Inclusion Criteria

Use Z02.2 When
  • Z codes should be used when a patient encounters healthcare services for reasons other than a specific illness or injury
  • 2 should be sequenced appropriately, often as a secondary code when a primary diagnosis is present
  • Payer requirements may vary, so it is essential to verify coverage for examinations related to residential admissions

Exclusion Criteria

Do NOT use Z02.2 When
No specific exclusions found.

Related CPT Codes

99381CPT Code

Preventive medicine evaluation and management, new patient, age 0-1

Clinical Scenario

Used in conjunction with Z02.2 for pediatric patients being evaluated for residential care.

Documentation Requirements

Complete history and physical examination, including developmental assessments.

Specialty Considerations

Primary care considerations for pediatric evaluations.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding encounters like Z02.2, allowing for better tracking of health status and social determinants that influence residential admissions.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding encounters like Z02.2, allowing for better tracking of health status and social determinants that influence residential admissions.

Reimbursement & Billing Impact

impact the patient's health and admission criteria.

Resources

Clinical References

  • •
    Preventive Services Task Force Recommendations

Coding & Billing References

  • •
    Preventive Services Task Force Recommendations

Frequently Asked Questions

What documentation is required for Z02.2?

Documentation must include a comprehensive health assessment, including physical and mental health evaluations, and any relevant social factors. It should clearly state the purpose of the encounter as related to residential admission.