Z43.0
BillableEncounter for attention to tracheostomy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z43.0 an HCC code?
Yes. Z43.0 maps to Respirator Dependence/Tracheostomy Status/Complications under the CMS-HCC V28 risk adjustment model (and Respirator Dependence/Tracheostomy Status under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for Z43.0
For Z43.0 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Z43.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z43.0 is the ICD-10-CM diagnosis code for encounter for attention to tracheostomy. A visit for routine care and maintenance of a tracheostomy, which is an opening in the windpipe that allows breathing when the normal airway is obstructed. Z43.0 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).
Under the CMS-HCC V28 risk adjustment model, Z43.0 maps to Respirator Dependence/Tracheostomy Status/Complications (HCC 211) with a community, non-dual, aged base RAF weight of 0.450. Under the older CMS-HCC V24 model, Z43.0 maps to Respirator Dependence/Tracheostomy Status (HCC 82) with a community, non-dual, aged base RAF weight of 1.241. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use this code for follow-up visits focused on tracheostomy care, cleaning, tube changes, or monitoring. Because Z43.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z43.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for follow-up visits focused on tracheostomy care, cleaning, tube changes, or monitoring
- •Document the reason for the tracheostomy (e.g., laryngeal stenosis, paralysis) separately if relevant to the encounter
Clinical Significance
Encounter for attention to tracheostomy indicates ongoing dependence on artificial airway requiring specialized nursing care and monitoring for complications. This represents significant functional limitation and need for complex respiratory management.
Documentation Requirements
- ✓Documentation of existing tracheostomy requiring attention
- ✓Specific care provided (cleaning, tube change, assessment)
- ✓Assessment of tracheostomy site and function
- ✓Patient's respiratory status and dependence level
- ✓Complications or problems addressed during visit
- ✓Education provided to patient or caregivers
- ✓Plans for ongoing tracheostomy management
- ✓Assessment of decannulation potential if applicable