Excludes1 pair
Z41.1 vs Z42-
Z41.1 and Z42 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on Z41.1
encounter for plastic and reconstructive surgery following medical procedure or healed injury (Z42.-)
Z41.1
Encounter for cosmetic surgery
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
Use when the record says
- Encounter for cosmetic breast implant
- Encounter for cosmetic procedure
Indexed under
- Admission › breast augmentation or reduction
- Admission › cosmetic surgery NEC
- Admission › plastic surgery, cosmetic NEC
- Encounter › breast augmentation or reduction
Z42
Encounter for plastic and reconstructive surgery following medical procedure or healed injury
Not billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
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