Z94.1 vs Z95.4
Z94.1 and Z95.4 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
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 (ed) (status)
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 (of)
- Presence › implanted device › heart valve › specified NEC (of)
- Replacement by artificial or mechanical device or prosthesis of › heart › valve › specified NEC
- Transplant › heart › valve › specified NEC (ed) (status)
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