2027 ICD-10-CM Diagnosis Code Z44.31Encounter for fitting and adjustment of external right breast prosthesis
Z44.31 is a billable ICD-10-CM diagnosis code for encounter for fitting and adjustment of external right breast prosthesis. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Implant, device or graft related encounter.
Code Identity
Code Classification
Present on Admission (POA)Billing
Z44.31 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Encounters for other specific health care (Z40-Z53).
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z44.31: its own notes plus those printed at Z44.3, Z44, block Z40-Z53, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- removal or replacement of external prosthetic device
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z44.31, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming Z44.31: they are not reported together with it, unless the two conditions are unrelated.
- Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Excludes2 5
These codes carry an Excludes2 note naming Z44.31: its condition is not part of those codes, and both may be reported when the patient has both.
- Block T80-T88 Complications of surgical and medical care, not elsewhere classifiedfitting and adjustment of external prosthetic device (Z44.-) names Z44.-, which includes this code
- Z43 Encounter for attention to artificial openings
- Z48 Encounter for other postprocedural aftercare
- Z96 Presence of other functional implants
- Z97 Presence of other devices
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Breast Reconstruction
If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z44.31 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z44.31Overview
Is Z44.31 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report encounter for fitting and adjustment of external right breast prosthesis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z44.31 group to?
When encounter for fitting and adjustment of external right breast prosthesis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Is Z44.31 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for encounter for fitting and adjustment of external right breast prosthesis on inpatient claims. The code appears in the Encounters for other specific health care (Z40-Z53) range of the CMS exempt list.
Can Z44.31 be reported with a code from T85.4?
Not as a rule. The Excludes1 note at Z44.3, which applies to Z44.31, lists "complications of breast implant (T85.4-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of Z44.31?
Under the General Equivalence Mappings, encounter for fitting and adjustment of external right breast prosthesis converts to ICD-9-CM V52.4 (fit/adj breast pros/impl). The mapping is approximate, so confirm the match fits the documentation.
