ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 Z04.71

Billable / Specific

Encounter for examination and observation following alleged adult physical abuse

Z04
Block
1
Synonyms
543
LCDs
6
Payer Policies
0
Linked CPTs

About ICD-10-CM Z04.71

ICD-10-CM code Z04.71 represents Encounter for examination and observation following alleged adult physical abuse. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z04). The 2026 edition of ICD-10-CM Z04.71 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under Z04.71. Per CMS ICD-10-CM Tabular 2026.

  • Suspected adult physical abuse, ruled out

Type 1 Excludes

Pure excludes, these codes can never be coded together with Z04.71. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • confirmed case of adult physical abuse (T74.-)
  • encounter for examination and observation following alleged adult sexual abuse (Z04.41)
  • suspected case of adult physical abuse, not ruled out (T76.-)

Medicare LCD Coverage for Z04.71

Local Coverage Determinations (LCDs) from CMS MACs that list Z04.71 as a covered diagnosis.

543 LCDs

Showing top 10 of 543 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87555 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87653 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87486 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87626 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 0109U →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87516 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87517 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87528 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87476 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87594 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Z04.71.

6 policies

5 Medicare

Billing and Coding: Visual Fields Testing
Policy ID: ART-56551
Billing and Coding: Visual Fields Testing
Policy ID: ART-56799
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58710
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58720
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58747

CPT Codes Commonly Billed with Z04.71

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for Z04.71

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert Z04.71 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
Z04.71 V7181 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To Z04.71

Other codes in section Z00-Z13 (Persons encountering health services for examinations).

Z00 Encounter for general examination without complaint, suspected or reported diagnosis (non-billable) Z00.0 Encounter for general adult medical examination (non-billable) Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings Z00.1 Encounter for newborn, infant and child health examinations (non-billable) Z00.11 Newborn health examination (non-billable) Z00.110 Health examination for newborn under 8 days old Z00.111 Health examination for newborn 8 to 28 days old Z00.12 Encounter for routine child health examination (non-billable) Z00.121 Encounter for routine child health examination with abnormal findings Z00.129 Encounter for routine child health examination without abnormal findings Z00.2 Encounter for examination for period of rapid growth in childhood Z00.3 Encounter for examination for adolescent development state Z00.5 Encounter for examination of potential donor of organ and tissue Z00.6 Encounter for examination for normal comparison and control in clinical research program Z00.7 Encounter for examination for period of delayed growth in childhood (non-billable) Z00.70 Encounter for examination for period of delayed growth in childhood without abnormal findings Z00.71 Encounter for examination for period of delayed growth in childhood with abnormal findings Z00.8 Encounter for other general examination Z01 Encounter for other special examination without complaint, suspected or reported diagnosis (non-billable)

ICD-10 Z04.71, Billing FAQ

Is ICD-10 code Z04.71 billable? +

Yes, Z04.71 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to Z04.71? +

ICD-10 Z04.71 includes: Suspected adult physical abuse, ruled out.

What codes are Type 1 Excludes for Z04.71? +

Type 1 Excludes (never code together with Z04.71): confirmed case of adult physical abuse (T74.-); encounter for examination and observation following alleged adult sexual abuse (Z04.41); suspected case of adult physical abuse, not ruled out (T76.-)

What ICD-9 codes does Z04.71 map to? +

Per CMS GEMs, Z04.71 maps to ICD-9 codes: V7181. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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