FY2027
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Excludes1 pair

Z94.1 vs Z95.4

Z94.1 and Z95.4 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 Z94.1
heart-valve replacement status (Z95.2-Z95.4)
Z94.1

Heart transplant status

Billable
Chapter 21
Factors influencing health status and contact with health services
Section
Z77-Z99
Indexed under
  • Transplant › heart
Z95.4

Presence of other heart-valve replacement

Billable
Chapter 21
Factors influencing health status and contact with health services
Section
Z77-Z99
Indexed under
  • Presence › heart valve implant › specified type NEC
  • Presence › implanted device › heart valve › specified NEC
  • Replacement by artificial or mechanical device or prosthesis of › heart › valve › specified NEC
  • Transplant › heart › valve › specified NEC

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