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2025 ICD-10-CM code Z03.818

Encounter for observation for suspected exposure to other biological agents ruled out.

Z03.818 should be the principal diagnosis if the sole reason for the encounter was the observation for suspected exposure.If other conditions are also addressed during the encounter, the reason for the encounter should determine the principal diagnosis.A procedure code must be reported if a procedure was performed during the encounter.

Medical necessity for Z03.818 is established by the reasonable suspicion of exposure to a biological agent, justifying the need for observation and testing to definitively rule out the exposure.Lack of signs or symptoms does not negate medical necessity if a credible concern exists.

The provider is responsible for evaluating the patient for the suspected exposure, ordering and reviewing appropriate tests, and documenting the rationale for the observation.

IMPORTANT:For COVID-19 related concerns, use Z20.828 (or Z20.822 after 2021-01-01) for actual or suspected exposure, or Z11.59 (or Z11.52 after 2021-01-01) for screening without known exposure.Use Z01.84 for antibody testing not related to confirming current or past COVID-19 infection.

In simple words: This code is used when someone is observed for a possible exposure to a biological agent (like a bacteria or virus, but not COVID-19), but tests show they weren't exposed.

This code is used when a person without a diagnosis is suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is ruled out.It is specifically used for suspected exposure to biological agents other than COVID-19 where the exposure is ruled out after evaluation.

Example 1: A patient presents to the clinic with concerns about possible exposure to anthrax after handling a suspicious package.After a thorough evaluation, including appropriate testing, anthrax exposure is ruled out, and the patient is discharged., A lab worker experiences a needle-stick injury while handling a sample potentially containing a dangerous pathogen. The worker is monitored and tested for the specific pathogen, and the results are negative., Following a bioterrorism event involving an unknown substance, a group of individuals are observed and tested for potential exposure.If the tests are negative for any specific biological agent, and no symptoms develop, Z03.818 is applicable.

Documentation should include details of the suspected exposure, the rationale for observation, results of any diagnostic tests performed, and the final determination ruling out the exposure.The documentation must support the medical necessity of the observation encounter.

** Do not use this code for encounters related to pregnancy and reproduction or for patients with symptoms; appropriate symptom codes should be used instead.Nonspecific abnormal findings should be coded using R70-R94.

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