FY2027
MenuClose
Excludes1 pair

Z43.4 vs Z46.5-

Z43.4 and Z46.5 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 Z46.5
encounter for attention to artificial openings of digestive tract (Z43.1-Z43.4)
Z43.4

Encounter for attention to other artificial openings of digestive tract

Billable
Chapter 21
Factors influencing health status and contact with health services
Section
Z40-Z53
Indexed under
  • Attention › jejunostomy
  • Admission › attention to artificial opening › enterostomy
  • Admission › attention to artificial opening › jejunostomy
  • Admission › attention to artificial opening › specified site NEC › intestinal tract
  • Attention › artificial › opening › digestive tract NEC
Z46.5

Encounter for fitting and adjustment of other gastrointestinal appliance and device

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