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Z43 ICD-10-CM Code: Encounter for attention to artificial openings

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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Encounters for other specific health care (Z40-Z53)

Z43

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Encounter for attention to artificial openings

Encounter for attention to artificial openings

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
Z4Encounters for other specific health care (Z40-Z53)
Z43Encounter for attention to artificial openings

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for Z43 in this effective period.

Excludes 2

Official
  • fitting and adjustment of prosthetic and other devices (Z44-Z46)

Related Child Codes

Official
Z43.0Encounter for attention to tracheostomy
Z43.1Encounter for attention to gastrostomy
Z43.2Encounter for attention to ileostomy
Z43.3Encounter for attention to colostomy
Z43.4Encounter for attention to other artificial openings of digestive tract

Includes

Official
  • closure of artificial openings
  • passage of sounds or bougies through artificial openings
  • reforming artificial openings
  • removal of catheter from artificial openings
  • toilet or cleansing of artificial openings

Excludes 1

Official
  • complications of external stoma (J95.0-, K94.-, N99.5-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for Z43 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for Z43 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for Z43 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

Z43 is the ICD-10-CM diagnosis code for encounter for attention to artificial openings. Z43 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering encounters for other specific health care (z40-z53).

Header codes like Z43 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at Z43's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Includes

  • closure of artificial openings
  • passage of sounds or bougies through artificial openings
  • reforming artificial openings
  • removal of catheter from artificial openings
  • toilet or cleansing of artificial openings

Excludes 1, Do NOT code together

Excludes 2, Not included here, may code separately

  • fitting and adjustment of prosthetic and other devices (Z44-Z46)

Child Codes

Code Hierarchy

Z43Encounter for attention to artificial openings
Z43Encounter for attention to artificial openings

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