2025 ICD-10-CM code Z43
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Encounters for other specific health care (Z40-Z53) Factors influencing health status and contact with health services (Z00-Z99) Feed
Encounter for attention to artificial openings.
Modifiers may apply to the accompanying procedure code based on the circumstances of the service provided.
Medical necessity is established by the need for routine care or treatment of complications related to the artificial opening.Documentation must support the medical necessity of the services provided.
The clinical responsibility depends on the specific services provided.This could involve a surgeon, gastroenterologist, urologist, or other specialists depending on the location of the artificial opening and the services rendered.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z40-Z53 Encounters for other specific health care
In simple words: This code is used when someone goes to the doctor for care related to a surgically created opening in their body, like a colostomy or ileostomy.The visit might be for cleaning, checking, or changing a device related to the opening.
This code is used to classify encounters for the purpose of attending to artificial openings, such as the cleaning, maintenance, or repair of ostomies, fistulas, or other surgically created openings.It includes procedures like closure, passage of instruments, reforming, catheter removal, toileting, or cleansing of artificial openings. It excludes complications of external stoma and fitting/adjustment of prosthetic devices.
Example 1: A patient with a colostomy presents for routine ostomy care, including irrigation and appliance change., A patient with a urostomy has a blockage and needs catheterization and irrigation of the stoma., A patient with a fistula undergoes surgical repair, and this Z code is used to denote attention to the artificial opening.
Complete documentation should include the type of artificial opening, the reason for the encounter (e.g., blockage, irritation, routine care), the procedures performed, and any complications or findings.
** This code is used for encounters focusing on the care and management of the artificial opening itself, not for the underlying condition that necessitated the creation of the opening.
- Revenue Code: Revenue codes will vary based on the specific services provided and the payer.
- RVU: RVUs will vary based on the specific procedures performed and the geographical location.Consult your local fee schedule for appropriate values.
- Global Days: Not applicable. Z codes are for diagnoses, not procedures.The global period applies to the procedure code used in conjunction with Z43, if any.
- Payment Status: Active
- Modifier TC rule: Not applicable to Z codes; this applies only to procedure codes.
- Fee Schedule: Fee schedules vary significantly by payer and location. Consult your payer's specific fee schedule for the relevant time period.
- Specialties:Gastroenterology, Urology, Colorectal Surgery, General Surgery
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center, Other