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Z43.6 vs Z93.6

Z43.6 (Encounter for attention to other artificial openings of urinary tract) compared with Z93.6 (Other artificial openings of urinary tract status), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes should not be reported together because Z93.6’s tabular entry lists Z43.6 under Excludes1.

Official rule
What is different?

The conditions named.Z43.6 is “Encounter for attention to other artificial openings of urinary tract”; Z93.6 is “Other artificial openings of urinary tract status”.

Registry fact

Can these codes be reported together?

No.Z93.6’s entry carries an Excludes1 note covering Z43.6: “artificial openings requiring attention or management (Z43.-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.Z93.6’s tabular entry: “artificial openings requiring attention or management (Z43.-)”. The note covers Z43.6.

Official ruleGuide: Excludes1 vs Excludes2

Nothing found in 4 other checks; 1 check does not apply
Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. Z43.6 carries 2 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

No.Both are billable codes, and neither contains the other.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

Z93.6
Other artificial openings of urinary tract status
↔
Z43.6
Encounter for attention to other artificial openings of urinary tract

What we found

No — do not report together.Z93.6 carries an Excludes1 note covering Z43.6: “artificial openings requiring attention or management (Z43.-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
Z43.6

Encounter for attention to other artificial openings of urinary tract

Z93.6

Other artificial openings of urinary tract status

StatusSame for both
Billable
Excludes1Differs
Only at Z43.6

No note of its own beyond the shared notes

Only at Z93.6
  • artificial openings requiring attention or management (Z43.-)
Shared by both codes (1 note)
  • complications of external stoma (J95.0-, K94.-, N99.5-)
Excludes2Differs
Z43.6
  • fitting and adjustment of prosthetic and other devices (Z44-Z46)
  • follow-up examination for medical surveillance after treatment (Z08-Z09)
Z93.6

None at this code

Code alsoDiffers
Z43.6

None at this code

Z93.6
  • any follow-up examination (Z08-Z09)
CategoryDiffers
Z43.6

Z43 Encounter for attention to artificial openings

Z93.6

Z93 Artificial opening status

ChapterSame for both

Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99)

IncludesDiffers
Z43.6
  • closure of artificial openings
  • passage of sounds or bougies through artificial openings
  • reforming artificial openings
  • removal of catheter from artificial openings
  • toilet or cleansing of artificial openings
  • Encounter for attention to nephrostomy
  • Encounter for attention to ureterostomy
  • Encounter for attention to urethrostomy
Z93.6
  • Nephrostomy status
  • Ureterostomy status
  • Urethrostomy status

No Code first, Use additional code and 7th character note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.

Editorial explanation — not an official CMS/CDC rule. Official coding instructions and source material are identified below. How to read the labels

The distinction

Z93.6 asserts that the patient has a nephrostomy, ureterostomy, or urethrostomy; Z43.6 asserts that this encounter is for servicing it — and because category Z93 excludes Z43.- by Excludes1, exactly one of them can appear on any claim.

The deciding question

Does the note describe work performed on the opening itself?

An exchange, closure, dilation, cleansing, or catheter removal documented at this encounter selects Z43.6 — category Z43’s Includes note lists exactly those services. If the note records only that the opening exists while treatment addresses something else, that is Z93.6, sequenced after the reason for the visit. And if the note describes a problem with the opening — infection, malfunction, hemorrhage — neither code applies: both categories exclude the complication family N99.5- by Excludes1.

Worked examples

Landing on Z43.6

A patient presents for a scheduled nephrostomy tube exchange; the note documents removal of the old catheter and placement of a new one, no complication found.

  1. Z43.6 — Encounter for attention to other artificial openings of urinary tract (first-listed)

Nothing else is required by the classification; Z93.6 must not be added.

Landing on Z93.6

A patient with a documented ureterostomy is treated for community-acquired pneumonia; the opening needs no attention during the stay.

  1. J18.9 — Pneumonia, unspecified organism (principal)
  2. Z93.6 — Other artificial openings of urinary tract status (secondary)

Why coders confuse them

The wrong pick is almost always Z93.6 on an attention encounter, and the reasoning behind it is sound-sounding: the patient does have ureterostomy status, the status code is billable, and the code titles share every anatomical word. The tell that the reasoning fails is positional — status describes the patient, not the visit. A visit needs a reason code, and for a tube exchange that reason is the attention code the Excludes1 points at.

The same instinct inverted — adding Z93.6 “for completeness” under a first-listed Z43.6 — fails on the same Excludes1 note. On Medicare inpatient claims the mistake is also machine-caught: Z93.6 sits on the MCE unacceptable-principal-diagnosis list (v44.0, edit 09) while Z43.6 does not.

FAQ

Which code is first-listed for a routine nephrostomy tube change, Z93.6 or Z43.6?

Z43.6. The aftercare guideline has attention codes “generally first listed,” and a tube change is squarely inside category Z43’s Includes note. Z93.6 cannot accompany it — Excludes1.

Why was a claim with Z93.6 as principal diagnosis rejected?

Because the Medicare Code Editor lists Z93.6 as an unacceptable principal diagnosis (v44.0, edit 09) on inpatient IPPS claims. The usual fix is not resequencing but replacing it — with Z43.6 if the encounter was for attention, or with N99.5- if it was for a complication.

What if the opening is infected or malfunctioning?

Then neither code applies: both categories carry an Excludes1 for “complications of external stoma,” which for the urinary tract is N99.5- (Complications of stoma of urinary tract). The complication code carries the encounter alone — it already establishes the opening exists.

When can a Z code be the primary diagnosis?·N99.5- — Complications of stoma of urinary tract

Edit this comparisonCheck a whole claim

Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources