Z43.6
BillableEncounter for attention to other artificial openings of urinary tract
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z43.6 an HCC code?
Yes. Z43.6 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 Z43.6
For Z43.6 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 Z43.6 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z43.6 is the ICD-10-CM diagnosis code for encounter for attention to other artificial openings of urinary tract. A medical visit to check on or adjust a surgically created opening in the urinary tract (such as a urostomy or ileal conduit) that allows urine to drain outside the body. Z43.6 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, Z43.6 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, Z43.6 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 when the patient is seen specifically for maintenance, cleaning, or adjustment of urinary tract artificial openings. Because Z43.6 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 Z43.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when the patient is seen specifically for maintenance, cleaning, or adjustment of urinary tract artificial openings
- •Do not use this code if the visit is for treatment of complications; use a more specific diagnosis code instead
Clinical Significance
Encounter for attention to other artificial openings of urinary tract indicates various urinary diversions requiring specialized urological management and monitoring. These diversions represent significant anatomical changes requiring ongoing medical supervision.
Documentation Requirements
- ✓Documentation of specific type of urinary tract artificial opening
- ✓Care provided during encounter (maintenance, assessment, irrigation)
- ✓Functional assessment of urinary diversion
- ✓Evaluation for complications such as stenosis or infection
- ✓Patient's management of urinary diversion
- ✓Educational interventions provided during visit
- ✓Plans for ongoing urological follow-up
- ✓Assessment of any surgical revision needs