Excludes1 pair
Z49- vs Z99.2
Z49 and Z99.2 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 Z99.2
encounter for fitting and adjustment of dialysis catheter (Z49.0-)
Z49
Encounter for care involving renal dialysis
Not billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z40-Z53
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 (hemodialysis) (peritoneal)
- Presence › arterial-venous shunt (dialysis)
- Shunt › arterial-venous (dialysis)
- Status › dialysis (hemodialysis) (peritoneal)
- Status › renal dialysis (hemodialysis) (peritoneal)
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