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Z95.811 ICD-10-CM Code: Presence of heart assist device

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Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes2 · 1 code-also instruction
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 186

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Code alsoMay be needed with this code
  • any follow-up examination (Z08-Z09)
Excludes2Not included here; may be reported together
  • complications of cardiac and vascular devices, implants and grafts (T82.-)

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 314 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC (MDC 05)
  • MS-DRG 315 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC (MDC 05)
  • MS-DRG 316 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC (MDC 05)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 223 — Heart Failure with Heart Assist Device/Artificial Heart (supersedes HCC 224, HCC 225, HCC 226, HCC 227)

Other models: CMS-HCC V22 HCC 186

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Z95.811 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on Z95.811 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from Z95

Code Also

Additional codes that may be required to fully describe the encounter.

  • any follow-up examination (Z08-Z09)

Source: inherited from Z77-Z99

Coder workflow for Z95.811

MedCoder structured workflow — derived from this code’s own official record

Before you code Z95.811

  1. Confirm the reason for the encounter this Z code records: a status — a condition, carrier state or sequela that may affect care, distinct from a current complication of it. Check whether the code may be reported as first-listed or principal — some Z codes are limited to one position — and do not report a history or status code for a condition documented as current. Z code categories and their reporting positions (Guidelines I.C.21.c.3, I.C.21.c.15).

    Guide: Status codes (Z codes) →

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The reason for the encounter
Whether the code records the encounter’s purpose, a status, or a history — and whether it may be first-listed (Guidelines I.C.21.c).

Official instructions as workflow

  • Excludes2 — not part of Z95.811(1 note)

    Coding workflow: The conditions named in this note are not included in Z95.811. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareT82

    See the official tabular notes · Guidelines I.A.12.b

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse Z95.811 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of Z95.811 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • T82— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of complications of cardiac and vascular devices, implants and grafts adds T82; it is not part of this code and both may be reported when both are documented.

    Full comparison: Z95.811 vs T82 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Presence of heart assist device is a billable ICD-10-CM diagnosis code (Z95.811).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

Code Z92.82 is only applicable to the receiving facility record and not to the transferring facility record. Z93 Artificial opening status Z94 Transplanted organ and tissue status Z95 Presence of cardiac and vascular implants and grafts Z96 Presence of other functional implants Z97 Presence of other devices Z98 Other postprocedural states Assign code Z98.85, Transplanted organ removal status, to indicate that a transplanted organ has been previously removed. This code should not be assigned for the encounter in which the transplanted organ is removed. The complication necessitating removal of the transplant organ should be assigned for that encounter.

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.
  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name Z95.811 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: Z18 — Retained foreign body fragments (via Z95.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 5 Excludes2 notes: Z45.018 — Encounter for adjustment and management of other part of cardiac pacemaker (via Z95.-), Z46 — Encounter for fitting and adjustment of other devices (via Z95.-), Z78 — Other specified health status (via Z95.-), Z87.7 — Personal history of (corrected) congenital malformations (via Z95.-), Z94 — Transplanted organ and tissue status (via Z95.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 21 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 314 (MDC 05), DRG 315 (MDC 05), DRG 316 (MDC 05).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR019 — Heart failure (default); FAC009 — Implant, device or graft related encounter.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

T86.21 — Heart transplant rejection, T86.22 — Heart transplant failure, T86.23 — Heart transplant infection, T86.290 — Cardiac allograft vasculopathy, T86.298 — Other complications of heart transplant, T86.30 — Unspecified complication of heart-lung transplant, T86.31 — Heart-lung transplant rejection, T86.32 — Heart-lung transplant failure, T86.33 — Heart-lung transplant infection, T86.39 — Other complications of heart-lung transplant, T86.850 — Intestine transplant rejection, T86.851 — Intestine transplant failure, T86.852 — Intestine transplant infection, T86.858 — Other complications of intestine transplant, T86.859 — Unspecified complication of intestine transplant, T86.90 — Unspecified complication of unspecified transplanted organ and tissue, T86.91 — Unspecified transplanted organ and tissue rejection, T86.92 — Unspecified transplanted organ and tissue failure, T86.93 — Unspecified transplanted organ and tissue infection, T86.99 — Other complications of unspecified transplanted organ and tissue, +1 more

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Heart Failure with Heart Assist Device/Artificial Heart) for risk-adjusted payment.

T82.512A — Breakdown (mechanical) of artificial heart, initial encounter, T82.522A — Displacement of artificial heart, initial encounter, T82.532A — Leakage of artificial heart, initial encounter, T82.592A — Other mechanical complication of artificial heart, initial encounter, Z95.812 — Presence of fully implantable artificial heart

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Acute on Chronic Heart Failure, Acute Heart Failure (Excludes Acute on Chronic), Heart Failure, Except End-Stage and Acute, Cardiomyopathy/Myocarditis

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Heart failure, Implant, device or graft related encounter).

Z46.82 — Encounter for fitting and adjustment of non-vascular catheter, Z46.89 — Encounter for fitting and adjustment of other specified devices, Z46.9 — Encounter for fitting and adjustment of unspecified device, Z95.0 — Presence of cardiac pacemaker, Z95.1 — Presence of aortocoronary bypass graft, Z95.2 — Presence of prosthetic heart valve, Z95.3 — Presence of xenogenic heart valve, Z95.4 — Presence of other heart-valve replacement, Z95.5 — Presence of coronary angioplasty implant and graft, Z95.810 — Presence of automatic (implantable) cardiac defibrillator, Z95.812 — Presence of fully implantable artificial heart, Z95.818 — Presence of other cardiac implants and grafts, Z95.820 — Peripheral vascular angioplasty status with implants and grafts, Z95.828 — Presence of other vascular implants and grafts, Z95.9 — Presence of cardiac and vascular implant and graft, unspecified, Z96.0 — Presence of urogenital implants, Z96.1 — Presence of intraocular lens, Z96.20 — Presence of otological and audiological implant, unspecified, Z96.21 — Cochlear implant status, Z96.22 — Myringotomy tube(s) status, +151 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Presence”; these codes share that main term but sit in a different category of the Tabular List.

D68.62 — Lupus anticoagulant syndrome (systemic lupus erythematosus [SLE] inhibitor), Z96.0 — Presence of urogenital implants (ureteral stent), Z96.1 — Presence of intraocular lens (artificial, lens), Z96.20 — Presence of otological and audiological implant, unspecified (ear implant), Z96.21 — Cochlear implant status (cochlear implant), Z96.22 — Myringotomy tube(s) status (myringotomy tube), Z96.29 — Presence of other otological and audiological implants (stapes implant), Z96.3 — Presence of artificial larynx (laryngeal implant), Z96.41 — Presence of insulin pump (external) (internal) (insulin pump), Z96.49 — Presence of other endocrine implants (endocrine implant NEC), Z96.5 — Presence of tooth-root and mandibular implants (tooth rootimplant), Z96.60 — Presence of unspecified orthopedic joint implant (joint implant), Z96.61 — Presence of artificial shoulder joint (shoulder-joint implant), Z96.62 — Presence of artificial elbow joint (elbow-joint implant), Z96.63 — Presence of artificial wrist joint (wrist-joint implant), Z96.64 — Presence of artificial hip joint (hip-joint implant), Z96.65 — Presence of artificial knee joint (knee-joint implant), Z96.66 — Presence of artificial ankle joint (ankle-joint implant), Z96.69 — Presence of other orthopedic joint implants (finger-joint implant), Z96.698 — Presence of other orthopedic joint implants (joint implant, specified joint NEC), +17 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Iron Panel, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of Z95.811 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run Z95.811 with these 6 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 223 — Heart Failure with Heart Assist Device/Artificial Heart [CMS-HCC]: “Heart Failure with Heart Assist Device/Artificial Heart — supersedes HCC 224 (Acute on Chronic Heart Failure), HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)), HCC 226 (Heart Failure, Except End-Stage and Acute), HCC 227 (Cardiomyopathy/Myocarditis)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 05 — Diseases and Disorders of the Circulatory System[MDC crossing]: “Diseases and Disorders of the Circulatory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 15,708 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Presence (of), device NEC (external), heart assist[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Presence (of), heart assist device[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (16)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Relevant guides

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

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

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Z95.811 — Presence of heart assist device." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/z95.811-presence-of-heart-assist-device

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Presence of heart assist device

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Z95.811 in its code family, with their registry titles.

View all codes in the Z95 family