Excludes1 pair
Z44.3- vs Z45-
Z44.3 and Z45 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 Z44.3
encounter for adjustment or removal of breast implant (Z45.81-)
Z44.3
Encounter for fitting and adjustment of external breast prosthesis
Not billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
Indexed under
- Admission › fitting › breast prosthesis (external)
- Fitting › artificial › breast
- Fitting › prosthesis › breast
- Admission › adjustment › breast › prosthesis (external)
- Admission › adjustment › prosthesis › breast
Z45
Encounter for adjustment and management of implanted device
Not billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
Use when the record says
- removal or replacement of implanted device
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