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ICD-10-CM Z43.9: Encounter for attention to unspecified artificial opening

Z43.9 is the billable ICD-10-CM code for encounter for attention to unspecified artificial opening, in category Z43 (Encounter for attention to artificial openings) of the Encounters for other specific health care section. As a principal diagnosis it groups to MS-DRG 951 Other Factors Influencing Health Status (MDC 23 MDC 23: Factors Influencing Health Status and Other Contacts with Health Services). It maps to HCC 463 (Artificial Openings for Feeding or Elimination) in CMS-HCC V28.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
Z43.9
billable FY2027 ICD-10-CM code
Category
Z43 Encounter for attention to artificial openings
Chapter
21: Factors influencing health status and contact with health services (Z00-Z99)
CC/MCC (MS-DRG v44)
Neither
CMS-HCC V28
HCC 463
POA reporting
Exempt

Tabular list notes for Z43.9

The tabular list has no notes on Z43.9 itself; the notes below apply from its parent headings.

Inherited from Z43 (Encounter for attention to artificial openings)

Includes
  • 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
Excludes1 (never coded together)
  • complications of external stoma (J95.0-, K94.-, N99.5-)
Excludes2 (not part of this condition, may be coded together)
  • fitting and adjustment of prosthetic and other devices (Z44-Z46)

MS-DRG grouping when Z43.9 is the principal diagnosis

MS-DRG v44 groups for Z43.9 as principal diagnosis
MDCMS-DRGs
23 MDC 23: Factors Influencing Health Status and Other Contacts with Health Services951

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for Z43.9 shows the full grouping logic.

CC/MCC status and inpatient edits

Z43.9 is neither a CC nor an MCC under MS-DRG v44, so as a secondary diagnosis it does not raise the MS-DRG severity level. Check Z43.9 against a principal diagnosis.

  • Present on admission: exempt from POA indicator reporting (FY2027 exempt list).
  • Medicare Code Editor: unacceptable principal diagnosis.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, Z43.9 maps to HCC 463 (Artificial Openings for Feeding or Elimination). The HCC lookup shows the RAF weight and the hierarchy.

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Frequently asked questions

What does ICD-10-CM Z43.9 mean?

Z43.9 means encounter for attention to unspecified artificial opening. It is one of 10 billable codes under Z43, encounter for attention to artificial openings.

What can't be coded with Z43.9?

Excludes1 at Z43: complications of external stoma (J95.0-, K94.-, N99.5-). These are never reported together with Z43.9.

Which MS-DRG does Z43.9 group to?

As the principal diagnosis, Z43.9 groups to MS-DRG 951 Other Factors Influencing Health Status (MDC 23 MDC 23: Factors Influencing Health Status and Other Contacts with Health Services) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does Z43.9 map to an HCC?

Yes: HCC 463, Artificial Openings for Feeding or Elimination, in the PY2027 CMS-HCC V28 mapping.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.