Annual Physical Exam ICD-10-CM codes

Z00.00 (general adult medical examination without abnormal findings) is the code for a routine physical in a patient 18 or older when nothing new is found. Use Z00.01 when the exam turns up a new abnormal finding, and add a code for that finding as a secondary diagnosis. Children from 29 days through 17 years use Z00.129 (without abnormal findings) or Z00.121 (with abnormal findings). Newborns use Z00.110 for the check under 8 days old and Z00.111 for 8 to 28 days. All of these are first-listed only; they cannot be reported as secondary diagnoses.

The abnormal findings rule trips up many practices. An abnormal finding is something newly discovered at the exam: a new murmur, an elevated blood pressure reading in an undiagnosed patient, an unexpected lab result. A stable chronic condition the patient already carries, such as hypertension or diabetes, does not convert the visit to Z00.01. Report Z00.00 first and list the chronic conditions addressed after it. Payers do audit Z00.01 claims for a supporting secondary code, so never report Z00.01 alone.

Pair Z00.0x and Z00.12x with the preventive medicine CPT codes 99381 to 99397, selected by age and new versus established status. If a significant, separately identifiable problem is also worked up, an office visit code with modifier 25 may be added, but the problem must have its own diagnosis code and its own documentation. Traditional Medicare does not cover a routine physical under Z00.00; it covers the Welcome to Medicare visit (G0402) and the annual wellness visit (G0438, G0439) instead, which are covered in a separate guide.

Administrative exams are not annual physicals. A sports physical is Z02.5, a pre-employment exam is Z02.1, and a school entry exam is Z02.0. Z00.8 covers other general exams that do not fit the routine categories, and Z00.2, Z00.3, Z00.70, and Z00.71 cover growth and development checks in children and adolescents.