ICD-10 Guide

Z02.5

Encounter for examination for participation in sport

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z02.5 is a billable code used to indicate a diagnosis of encounter for examination for participation in sport.

Key Diagnostic Point:

Z02.5 is utilized for encounters where an individual undergoes a medical examination to assess their fitness for participation in sports activities. This examination is crucial for ensuring that athletes, especially children and adolescents, are physically capable of engaging in sports without undue risk of injury. The examination may include assessments of cardiovascular health, musculoskeletal integrity, and overall physical fitness. Social determinants of health, such as access to healthcare, socioeconomic status, and community resources, can influence an individual's ability to participate in sports. Preventive care is emphasized in these encounters, as they can help identify potential health issues before they become serious, thereby promoting long-term health and well-being. Screening for conditions such as asthma, hypertension, and obesity is often part of the examination process. Aftercare may involve follow-up appointments to monitor any identified health concerns or to provide guidance on safe sports participation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Need for comprehensive documentation of physical examination findings
Variability in state or school requirements for sports participation exams
Potential for co-existing conditions that require additional coding
Understanding of preventive care guidelines and their application

Audit Risk Factors

Inadequate documentation of the examination findings
Failure to document the purpose of the encounter clearly
Misuse of Z02.5 when a different primary diagnosis exists
Lack of follow-up documentation if issues are identified

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include a detailed physical examination, any relevant medical history, and specific assessments related to sports participation.

Common Clinical Scenarios

Routine checkups for school sports, evaluations for community sports leagues, and follow-up visits for previously identified health issues.

Billing Considerations

Consideration of social determinants such as access to sports programs, socioeconomic status, and community health resources.

Public Health

Documentation Requirements

Documentation should focus on population health data, trends in sports participation, and health outcomes related to physical activity.

Common Clinical Scenarios

Community health initiatives promoting sports participation, epidemiological studies on sports-related injuries, and preventive health campaigns.

Billing Considerations

Emphasis on tracking health disparities and access to sports programs in various communities.

Coding Guidelines

Inclusion Criteria

Use Z02.5 When

Z codes should be used when the encounter is for a specific purpose, such as a sports examination
They are typically sequenced after any primary diagnosis
Payer requirements may vary, so it is essential to verify coverage for preventive examinations

Exclusion Criteria

Do NOT use Z02.5 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 Z02.5 for comprehensive preventive care during sports physicals.

Documentation Requirements

Documentation must include a complete history and physical examination.

Specialty Considerations

Primary care providers should ensure all preventive measures are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters like Z02.5, enabling better tracking of sports participation and associated health outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters like Z02.5, enabling better tracking of sports participation and associated health outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters like Z02.5, enabling better tracking of sports participation and associated health outcomes.

Resources

Clinical References

•
CDC Physical Activity Guidelines

Coding & Billing References

•
CDC Physical Activity Guidelines

Frequently Asked Questions

What documentation is required for Z02.5?

Documentation must include a detailed physical examination, any relevant medical history, and specific assessments related to sports participation. It should also address any identified health concerns and recommendations for follow-up care.

ICD-10 Z02.5 is a billable code used to indicate a diagnosis of encounter for examination for participation in sport.