Z43.4
BillableEncounter for attention to other artificial openings of digestive tract
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z43.4 an HCC code?
Yes. Z43.4 maps to Artificial Openings for Feeding or Elimination under the CMS-HCC V28 risk adjustment model (and Artificial Openings for Feeding or Elimination 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 Z43.4
For Z43.4 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 Z43.4 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z43.4 is the ICD-10-CM diagnosis code for encounter for attention to other artificial openings of digestive tract. A visit for routine care and maintenance of other surgically created openings in the digestive tract, such as jejunostomy or other artificial digestive openings. Z43.4 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, Z43.4 maps to Artificial Openings for Feeding or Elimination (HCC 463) with a community, non-dual, aged base RAF weight of 0.233. Under the older V24 model, Z43.4 mapped to the same category but with a base RAF weight of 0.570 — V28 recalibrated weights across the entire model. 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 artificial openings of the digestive tract not specified by Z43.1, Z43.2, or Z43.3. Because Z43.4 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 Z43.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Encounter for attention to other artificial openings of digestive tract encompasses various surgical diversions requiring specialized management and monitoring. These openings represent significant anatomical alterations requiring ongoing medical supervision and patient education.
Documentation Requirements
- ✓Documentation of specific type of artificial digestive opening
- ✓Care provided during encounter (maintenance, assessment, education)
- ✓Functional assessment of the artificial opening
- ✓Evaluation for complications or problems
- ✓Patient's adaptation to artificial opening management
- ✓Educational needs addressed during visit
- ✓Plans for ongoing management and follow-up care
- ✓Assessment of any revision or closure possibilities