Excludes1 pair
Z45- vs Z46.1
Z45 and Z46.1 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 Z46.1
encounter for adjustment and management of implanted hearing device (Z45.32-)
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
Z46.1
Encounter for fitting and adjustment of hearing aid
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
Indexed under
- Fitting › hearing aid
- Admission › adjustment › hearing aid
- Admission › fitting › hearing aid
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