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ICD-10 Guide
ICD-10 CodesZ04.2

Z04.2

Encounter for examination and observation following work accident

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

Code Description

ICD-10 Z04.2 is a billable code used to indicate a diagnosis of encounter for examination and observation following work accident.

Key Diagnostic Point:

Z04.2 is used to classify encounters for examination and observation following a work-related accident. This code is crucial for capturing the health status of individuals who have experienced workplace injuries, which can significantly impact their physical and mental well-being. The examination may include assessments for physical injuries, psychological evaluations, and screenings for potential long-term effects of the accident. Social determinants of health, such as workplace safety conditions, access to healthcare, and socioeconomic factors, play a vital role in the recovery process. Preventive care measures, including follow-up appointments and rehabilitation services, are essential to ensure that individuals receive comprehensive care post-accident. This code also highlights the importance of workplace safety initiatives and the need for employers to provide adequate support for injured employees, thereby influencing overall health outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for detailed documentation of the accident and subsequent examination
  • Variability in the types of injuries and required follow-up care
  • Potential for co-existing conditions that may complicate coding
  • Importance of linking the encounter to the specific work-related injury

Audit Risk Factors

  • Inadequate documentation of the work accident details
  • Failure to link the Z code to the primary diagnosis of the injury
  • Incorrect sequencing of codes, especially with co-existing conditions
  • Lack of follow-up documentation for aftercare services

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include details of the work accident, examination findings, and any referrals for further care or rehabilitation.

Common Clinical Scenarios

Routine checkups post-accident, screenings for psychological impact, and aftercare for physical rehabilitation.

Billing Considerations

Consideration of social determinants such as the patient's work environment and access to follow-up care.

Public Health

Documentation Requirements

Documentation should focus on population-level data regarding workplace injuries and health outcomes.

Common Clinical Scenarios

Epidemiological studies on workplace safety and preventive health measures.

Billing Considerations

Tracking health status trends related to occupational health and safety.

Coding Guidelines

Inclusion Criteria

Use Z04.2 When
  • Z codes are used when a patient encounters health services for reasons other than a current illness or injury
  • 2 should be sequenced appropriately, often following the primary diagnosis code related to the work accident
  • Payer requirements may vary, so coders should ensure compliance with specific documentation and coding standards

Exclusion Criteria

Do NOT use Z04.2 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits after a work accident, focusing on examination and observation.

Documentation Requirements

Documentation must include details of the work accident, examination findings, and any referrals.

Specialty Considerations

Primary care providers should ensure comprehensive documentation to support the use of Z04.2.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters related to work accidents, improving the ability to track and analyze workplace injuries and their outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters related to work accidents, improving the ability to track and analyze workplace injuries and their outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters related to work accidents, improving the ability to track and analyze workplace injuries and their outcomes.

Resources

Clinical References

  • •
    CDC Workplace Safety Guidelines

Coding & Billing References

  • •
    CDC Workplace Safety Guidelines

Frequently Asked Questions

When should Z04.2 be used?

Z04.2 should be used when a patient presents for examination and observation following a work-related accident, ensuring that the encounter is well-documented and linked to the primary diagnosis.