2025 ICD-10-CM code Z02
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Encounter for administrative examination Factors influencing health status and contact with health services (Z00-Z99) Feed
Encounter for administrative examination;This code is used when a patient has an examination for administrative reasons, such as a pre-employment physical or a certificate for insurance.
Modifiers may be applicable depending on the circumstances of the examination and the specific procedures performed. Consult payer-specific guidelines and modifier instructions for accurate reporting.
Medical necessity for Z02 codes is typically determined by the requesting entity's requirements.For example, pre-employment physicals are often mandated by employers for safety reasons. However, if the encounter is solely for administrative purposes and no medical evaluation is performed, the services may not be considered medically necessary by some payers.
The clinical responsibility lies with the physician conducting the examination. This includes performing the necessary assessments, recording findings, and issuing any required certificates or reports.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z00-Z99 (Factors influencing health status and contact with health services) > Z00-Z13 (Persons encountering health services for examinations)
In simple words: This code means the patient had a checkup for administrative reasons, like a physical for a new job, school, or to get a certificate from a doctor.
This ICD-10-CM code, Z02, signifies an encounter for an administrative examination.This encompasses examinations conducted for reasons unrelated to the diagnosis or treatment of an illness or symptom, often at the request of third parties like employers, schools, or insurance companies.Examples include pre-employment physicals, examinations for admission to educational or residential institutions, fitness-for-duty evaluations, or examinations to obtain a driver's license or medical certificate.The examination may assess the patient's current health status, resulting in a certificate or other administrative documentation. A corresponding procedure code should be included if a procedure is performed during the examination.Note that if the sole purpose of the encounter is administrative, the code should be listed as the principal diagnosis on the claim.
Example 1: A 25-year-old is applying for a new job and needs a pre-employment physical examination.The physician performs a general physical exam, including height, weight, vital signs, and a review of systems.Z02.1 (Encounter for pre-employment examination) would be the appropriate code., A 60-year-old needs an examination to renew their driver's license.The physician assesses their visual acuity, reflexes, and cognitive function. Z02.4 (Encounter for examination for driving license) is coded., A 40-year-old patient requires a medical certificate for disability determination. The physician performs a comprehensive evaluation of their physical and mental health conditions.Code Z02.71 (Encounter for disability determination) would be used.
Complete medical records should include a detailed history and physical exam findings relevant to the administrative reason for the encounter.Documentation must clearly explain the purpose of the examination and any findings.Any procedures performed should be documented with appropriate CPT or HCPCS codes.Supporting documentation such as employer requests or insurance forms may also be required.
** Accurate coding requires appropriate documentation supporting the medical necessity and the reason for the administrative examination.Always refer to your payer's guidelines and coding manuals for the most up-to-date information.Z02 should be used as the primary diagnosis only when the encounter is primarily for administrative purposes.If another diagnosis is the primary reason for the visit, this should be coded instead.
- Revenue Code: Revenue codes will vary depending on the specific services provided during the administrative examination and the payer's guidelines.
- RVU: RVUs will depend on the specific services rendered during the examination and will vary based on location and payer.
- Global Days: Not applicable; this is a diagnosis code, not a procedure code with a global period.
- Payment Status: Active, but payment is contingent upon medical necessity and the absence of solely administrative purposes.
- Modifier TC rule: Not applicable; this is a diagnosis code, not a procedure code.
- Fee Schedule: Fee schedules vary by payer and location.Historical fee information can be obtained through payer websites or fee schedule databases.
- Specialties:Numerous medical specialties can use Z02, depending on the nature of the administrative examination.Examples include Occupational Medicine, Family Medicine, and Internal Medicine.
- Place of Service:The place of service will depend on where the examination occurs, which may include the physician's office, a clinic, or other appropriate healthcare setting.Examples include Office, Clinic, or other appropriate healthcare setting based on the context of the exam.