2027 ICD-10-CM Diagnosis Code Z91.843Risk for dental caries, high
Z91.843 is a billable ICD-10-CM diagnosis code for risk for dental caries, high. 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 not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. Coders also document this condition as at extreme risk for dental caries. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified status.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z91.843.
Present on Admission (POA)Billing
Z91.843 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- At extreme risk for dental caries
- At high risk for dental caries
- At increased risk for dental caries
- Bottle feeding routine with high risk of developing dental caries
- Breastfeeding routine with high risk of developing dental caries
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z91.843: its own notes plus those printed at Z91, block Z77-Z99, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
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.
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
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.
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Tooth Decay
Tooth decay is damage to a tooth's surface, or enamel. It happens when bacteria in your mouth make acids that attack the enamel. Tooth decay can lead to cavities (dental caries), which are holes in your teeth. If tooth decay is not treated, it can cause pain, infection, and even tooth loss.
The full article covers:
- What is tooth decay?
- What causes tooth decay?
- Who is at risk for tooth decay?
- What are the symptoms of tooth decay and cavities?
- How are tooth decay and cavities diagnosed?
- What are the treatments for tooth decay and cavities?
- Can tooth decay be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z91.843 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement Z91.843 replaces the following previously assigned code(s):
- Z91.89 - Oth personal risk factors, not elsewhere classified
Questions About Z91.843Overview
What is the ICD-10 code for risk for dental caries, high?
The ICD-10-CM code for risk for dental caries, high is Z91.843 (sometimes written as Z91843). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z91.843 (Oral health risk factors) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report risk for dental caries, high on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z91.843 group to?
On inpatient claims, risk for dental caries, high maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Can Z91.843 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because risk for dental caries, high describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Is Z91.843 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 risk for dental caries, high on inpatient claims. The code appears in the Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99) range of the CMS exempt list.
