Z43.1 Encounter for attention to gastrostomy

Billable ICD-10-CM code, FY2026. Acts as a Complication or Comorbidity (CC) as a secondary diagnosis. Exempt from present-on-admission (POA) reporting.

Excludes2 (not included here)

• artificial opening status only, without need for care (Z93.-)

Applies 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 code together)

• complications of external stoma (J95.0-, K94.-, N99.5-)

Excludes2 (not included here)

• fitting and adjustment of prosthetic and other devices (Z44-Z46)

Risk adjustment (HCC)

• CMS-HCC V28: HCC 463 — Artificial Openings for Feeding or Elimination
• CMS-HCC V22: HCC 188 — Artificial Openings for Feeding or Elimination
• ESRD V24: HCC 188

MS-DRG index

Defines the logic of DRG(s) 393-395 in MDC 06.

Approximate ICD-9-CM (GEMs)

• V55.1 Attention to gastrostomy

Code annotations containing back-references to Z43.1

Back-references to Z43.1

• Type 1 Excludes: Z46.5 Encounter for fitting and adjustment of other gastrointestinal appliance and device ("encounter for attention to artificial openings of digestive tract (Z43.1-Z43.4)")

Back-references to Z43

• Type 1 Excludes: Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm ("aftercare following medical care (Z43-Z49, Z51)")
• Type 1 Excludes: Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm ("aftercare following medical care (Z43-Z49, Z51)")
• Type 2 Excludes: Z48 Encounter for other postprocedural aftercare ("encounter for attention to artificial openings (Z43.-)")
• Type 1 Excludes: Z93 Artificial opening status ("artificial openings requiring attention or management (Z43.-)")
• Type 2 Excludes: Z98 Other postprocedural states ("aftercare (Z43-Z49, Z51)")

Diagnosis Index entries for Z43.1

• Admission (for) › attention to artificial opening (of) › gastrostomy
• Attention (to) › artificial › opening (of) › digestive tract NEC › stomach
• Attention (to) › gastrostomy
• Gastrostomy › attention to

Nearby codes

• Z43 Encounter for attention to artificial openings
• Z43.0 Encounter for attention to tracheostomy
• Z43.1 Encounter for attention to gastrostomy (this code)
• Z43.2 Encounter for attention to ileostomy
• Z43.3 Encounter for attention to colostomy
• Z43.4 Encounter for attention to other artificial openings of digestive tract
• Z43.5 Encounter for attention to cystostomy
• Z43.6 Encounter for attention to other artificial openings of urinary tract