Z43.1 vs Z46.5
Z43.1 (Encounter for attention to gastrostomy) compared with Z46.5 (Encounter for fitting and adjustment of other gastrointestinal appliance and device), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
Yes, when both are documented. Z43.1 carries an Excludes2 note covering Z46.5: “fitting and adjustment of prosthetic and other devices (Z44-Z46)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
No — do not report together. Z46.5 carries an Excludes1 note covering Z43.1: “encounter for attention to artificial openings of digestive tract (Z43.1-Z43.4)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| Z43.1Encounter for attention to gastrostomy | Z46.5Encounter for fitting and adjustment of other gastrointestinal appliance and device | |
|---|---|---|
| Billing status | Billable | Non-billable header |
| Classification | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) |
| Definition | Encounter for attention to gastrostomy is a billable ICD-10-CM diagnosis code (Z43.1). | Encounter for fitting and adjustment of other gastrointestinal appliance and device is a non-billable ICD-10-CM category code (Z46.5). |
| Includes | closure of artificial openings passage of sounds or bougies through artificial openings reforming artificial openings removal of catheter from artificial openings | removal or replacement of other device |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources