Z93.1 ICD-10-CM Code: Gastrostomy status
Z93.1 maps to CMS-HCC V28 463. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z93.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGastrostomy status
A patient has a gastrostomy, which is a surgically created opening in the stomach that allows for feeding tube placement when oral intake is not possible.
Buddy Insight
This code indicates a major alteration in nutritional intake method that significantly increases care complexity and infection risk.
CMS-HCC V28
MappedHCC 463
Coefficient HCC 463: 0.673 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 253
Code-level coefficient reference
ESRD/PACE
MappedHCC 188
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for Z93.1. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for Z93.1. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for Z93.1. Check the code and parent instructions in the Code Book.
Excludes 1
Official- artificial openings requiring attention or management (Z43.-)Inherited from Z93
- complications of external stoma (J95.0-, K94.-, N99.5-)Inherited from Z93
Code First
OfficialNo Code First sequencing instructions are included in this display for Z93.1. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for Z93.1. Check the code and parent instructions in the Code Book.
Code Also
Official- any follow-up examination (Z08-Z09)Inherited from Z77-Z99
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Z93.1 an HCC code?
Yes. Z93.1 (Gastrostomy status) maps to HCC 463, Artificial Openings for Feeding or Elimination under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.673. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: Z93.1 is billable and maps to V28 HCC 463, Artificial Openings for Feeding or Elimination. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Z93.1
- Description
- Gastrostomy status
- HCC (V28)
- HCC 463 — Artificial Openings for Feeding or Elimination
- RAF reference coefficient
- 0.673
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work Z93.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for Z93.1
For Z93.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
Z93.1 is the ICD-10-CM diagnosis code for gastrostomy status. A patient has a gastrostomy, which is a surgically created opening in the stomach that allows for feeding tube placement when oral intake is not possible. Z93.1 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Under the CMS-HCC V28 risk adjustment model, Z93.1 maps to Artificial Openings for Feeding or Elimination (HCC 463) with a source-labeled community, non-dual, aged reference coefficient of 0.673. No V24 mapping is shown for Z93.1; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code for all patients with a gastrostomy tube (G-tube) in place, regardless of whether it is currently being used. For Z93.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for Z93.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for all patients with a gastrostomy tube (G-tube) in place, regardless of whether it is currently being used
- •Document the reason for the gastrostomy (e.g., dysphagia, neurological condition) in the medical record for clinical context
Clinical Significance
This code indicates a major alteration in nutritional intake method that significantly increases care complexity and infection risk. Gastrostomy status often reflects underlying conditions affecting swallowing or gastrointestinal function and requires specialized nursing care and nutritional management.
Documentation Requirements
- ✓Confirmation of active gastrostomy presence
- ✓Type of gastrostomy (PEG, surgical, button)
- ✓Indication for gastrostomy creation
- ✓Current functionality and patency
- ✓Nutritional support method and frequency
- ✓Care requirements and complications
- ✓Planned duration or permanence
- ✓Underlying condition necessitating gastrostomy