I77.0 vs Z99.2
I77.0 and Z99.2 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on I77.0
presence of arteriovenous shunt (fistula) for dialysis (Z99.2)
I77.0
Arteriovenous fistula, acquired
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I70-I79
Use when the record says
- Aneurysmal varix
- Arteriovenous aneurysm, acquired
Indexed under
- Fistula › arteriovenous (cutaneous)
- Varicose › aneurysm
- Varix › aneurysmal (lower limb)
- Aneurysm › arteriovenous › acquired (anastomotic) (artery) (cirsoid) (diffuse) (false) (fusiform) (multiple) (saccular)
- Aneurysm › arteriovenous › specified site NEC › acquired (anastomotic) (artery) (cirsoid) (diffuse) (false) (fusiform) (multiple) (saccular)
Z99.2
Dependence on renal dialysis
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z77-Z99
Use when the record says
- Hemodialysis status
- Peritoneal dialysis status
- Presence of arteriovenous shunt for dialysis
- Renal dialysis status NOS
Indexed under
- Dialysis › renal, status (intermittent) (treatment)
- Presence › arterial-venous shunt (of)
- Shunt › arterial-venous
- Status › dialysis (post)
- Status › renal dialysis (post)
These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027