Is ICD-10-CM code Z96 billable?

No, Z96 (Presence of other functional implants) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code Z96 belong to?

Z96 belongs to Chapter 21 of the ICD-10-CM tabular list: Z00–Z99 (Factors Influencing Health Status and Contact with Health Services).

Z96Not billable, use a more specific code below

Presence of other functional implants

In Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99), chapter 21: Factors Influencing Health Status and Contact with Health Services

40 billable codes under Z96: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes2: not included here, code separately if applicable

complications of internal prosthetic devices, implants and grafts (T82-T85)
fitting and adjustment of prosthetic and other devices (Z44-Z46)

Also applies, from Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)

These notes sit on Z77-Z99 and apply to every code under it, including Z96.

Code also: add a code for this too, order depends on the encounter

any follow-up examination (Z08-Z09)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers when and how to use Z codes (Z00-Z99) for encounters and supplementary information, including contact, status, history, screening, aftercare, exams, and social determinants of health.

Use of Z Codes in Any Healthcare Setting (page 92)
Z Codes Indicate a Reason for an Encounter or Provide Additional Information about a Patient Encounter (page 93)
Categories of Z Codes (page 93)

Read Section I.C.21 (page 92)

All codes under Z96

Z96 can't be used on a claim. Pick a billable code below; grey headings group them.

Z96 MS-DRGs

As the principal diagnosis, the billable codes under Z96 group to these 9 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 564 Other Musculoskeletal System and Connective Tissue Diagnoses with MCC (26 of 40 codes)
DRG 565 Other Musculoskeletal System and Connective Tissue Diagnoses with CC (26 of 40 codes)
DRG 566 Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC (26 of 40 codes)
DRG 951 Other Factors Influencing Health Status (9 of 40 codes)
DRG 124 Other Disorders of the Eye with MCC or Thrombolytic Agent (1 of 40 codes)
DRG 125 Other Disorders of the Eye without MCC (1 of 40 codes)
DRG 698 Other Kidney and Urinary Tract Diagnoses with MCC (1 of 40 codes)
DRG 699 Other Kidney and Urinary Tract Diagnoses with CC (1 of 40 codes)
DRG 700 Other Kidney and Urinary Tract Diagnoses without CC/MCC (1 of 40 codes)

Other codes that refer to Z96

Notes on these codes point to Z96.

M96 Excludes2: presence of functional implants and other devices (Z96-Z97)
Z18 Excludes1: organ or tissue replaced by means other than transplant (Z96.-, Z97.-)
Z87.7 Excludes2: presence of other functional implants (Z96.-)

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.