ICD-10 Guide

Z02.81

Encounter for paternity testing

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z02.81 is a billable code used to indicate a diagnosis of encounter for paternity testing.

Key Diagnostic Point:

Z02.81 is used to indicate an encounter specifically for paternity testing, which is often requested for legal, social, or personal reasons. This code is relevant in contexts where the determination of biological parentage is necessary, impacting the health status of the child and the family dynamics. Factors influencing health status may include the psychological impact of paternity uncertainty, the need for genetic counseling, and the implications for custody or child support. Social determinants such as socioeconomic status, access to healthcare, and family structure can significantly affect the decision to pursue paternity testing. Preventive care may involve counseling on the implications of test results, while screening may include assessments for genetic conditions that could affect the child. Aftercare may involve follow-up appointments to discuss results and any necessary interventions based on the findings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Documentation of the reason for testing (legal, personal, etc.)
Potential for emotional and psychological factors influencing the encounter
Need for genetic counseling and implications of results
Variability in payer requirements for coverage of paternity testing

Audit Risk Factors

Inadequate documentation of the reason for testing
Failure to document counseling provided regarding test implications
Incorrect sequencing of codes related to the encounter
Lack of supporting documentation for medical necessity

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include the reason for the encounter, any counseling provided, and follow-up plans.

Common Clinical Scenarios

Patients seeking paternity testing for custody disputes, child support issues, or personal reasons.

Billing Considerations

Consideration of social determinants such as family dynamics, socioeconomic status, and access to mental health resources.

Public Health

Documentation Requirements

Documentation should include population-level data on paternity testing trends and outcomes.

Common Clinical Scenarios

Public health initiatives aimed at understanding the implications of paternity testing on child health and welfare.

Billing Considerations

Focus on tracking health outcomes related to paternity testing and its impact on community health.

Coding Guidelines

Inclusion Criteria

Use Z02.81 When

Z codes should be used when the encounter is not for a current illness or injury but for a specific reason such as paternity testing
Proper sequencing is essential, especially if other diagnoses are present
Payer requirements may vary, so it is crucial to verify coverage for paternity testing

Exclusion Criteria

Do NOT use Z02.81 When

No specific exclusions found.

Related CPT Codes

81200CPT Code

DNA paternity testing

Clinical Scenario

Used in conjunction with Z02.81 for encounters specifically for paternity testing.

Documentation Requirements

Documentation must include the reason for testing and any counseling provided.

Specialty Considerations

Primary care providers should ensure comprehensive documentation of the encounter context.

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 paternity testing, emphasizing the importance of detailed documentation and the context of the encounter.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters like paternity testing, emphasizing the importance of detailed documentation and the context of the encounter.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters like paternity testing, emphasizing the importance of detailed documentation and the context of the encounter.

Resources

Clinical References

•
CDC Guidelines on Genetic Testing

Coding & Billing References

•
CDC Guidelines on Genetic Testing

Frequently Asked Questions

What documentation is required for Z02.81?

Documentation must include the reason for the paternity test, any counseling provided regarding the implications of the results, and follow-up plans. This ensures compliance with coding guidelines and supports medical necessity.

ICD-10 Z02.81 is a billable code used to indicate a diagnosis of encounter for paternity testing.