Chapter XXI
Factors influencing health status and contact with health services
(Z00-Z99)

Persons encountering health services for specific procedures and health care
(Z40-Z54)

Note: Categories Z40-Z54 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving follow-up or prophylactic care, convalescent care, or care to consolidate the treatment, to deal with residual states, to ensure that the condition has not recurred, or to prevent recurrence.
Excludes: follow-up examination for medical surveillance after treatment ( Z08-Z09 )

Z40 Prophylactic surgery
Z40.0 Prophylactic surgery for risk-factors related to malignant neoplasms
Admission for prophylactic organ removal
Z40.8 Other prophylactic surgery
Z40.9 Prophylactic surgery, unspecified

Z41 Procedures for purposes other than remedying health state
Z41.0 Hair transplant
Z41.1 Other plastic surgery for unacceptable cosmetic appearance
Breast implant
Excludes: plastic and reconstructive surgery following healed injury or operation ( Z42.- )
Z41.2 Routine and ritual circumcision
Z41.3 Ear piercing
Z41.8 Other procedures for purposes other than remedying health state
Z41.9 Procedure for purposes other than remedying health state, unspecified

Z42 Follow-up care involving plastic surgery
Includes: plastic and reconstructive surgery following healed injury or operation
repair of scarred tissue
Excludes: plastic surgery:
· as treatment for current injury - code to relevant injury - see Alphabetical Index
· for unacceptable cosmetic appearance ( Z41.1 )
Z42.0 Follow-up care involving plastic surgery of head and neck
Z42.1 Follow-up care involving plastic surgery of breast
Z42.2 Follow-up care involving plastic surgery of other parts of trunk
Z42.3 Follow-up care involving plastic surgery of upper extremity
Z42.4 Follow-up care involving plastic surgery of lower extremity
Z42.8 Follow-up care involving plastic surgery of other body part
Z42.9 Follow-up care involving plastic surgery, unspecified

Z43 Attention to artificial openings
Includes: closure
passage of sounds or bougies
reforming
removal of catheter
toilet or cleansing
Excludes: artificial opening status only, without need for care ( Z93.- )
complications of external stoma ( J95.0 , K91.4 , N99.5 )
fitting and adjustment of prosthetic and other devices ( Z44-Z46 )
Z43.0 Attention to tracheostomy
Z43.1 Attention to gastrostomy
Z43.2 Attention to ileostomy
Z43.3 Attention to colostomy
Z43.4 Attention to other artificial openings of digestive tract
Z43.5 Attention to cystostomy
Z43.6 Attention to other artificial openings of urinary tract
Nephrostomy
Ureterostomy
Urethrostomy
Z43.7 Attention to artificial vagina
Z43.8 Attention to other artificial openings
Z43.9 Attention to unspecified artificial opening

Z44 Fitting and adjustment of external prosthetic device
Excludes: presence of prosthetic device ( Z97.- )
Z44.0 Fitting and adjustment of artificial arm (complete)(partial)
Z44.1 Fitting and adjustment of artificial leg (complete)(partial)
Z44.2 Fitting and adjustment of artificial eye
Excludes: mechanical complication of ocular prosthesis ( T85.3 )
Z44.3 Fitting and adjustment of external breast prosthesis
Z44.8 Fitting and adjustment of other external prosthetic devices
Z44.9 Fitting and adjustment of unspecified external prosthetic device

Z45 Adjustment and management of implanted device
Excludes: malfunction or other complications of device - see Alphabetical Index
presence of prosthetic and other devices ( Z95-Z97 )
Z45.0 Adjustment and management of cardiac pacemaker
Checking and testing of pulse generator [battery]
Z45.1 Adjustment and management of infusion pump
Z45.2 Adjustment and management of vascular access device
Z45.3 Adjustment and management of implanted hearing device
Bone conduction device
Cochlear device
Z45.8 Adjustment and management of other implanted devices
Z45.9 Adjustment and management of unspecified implanted device

Z46 Fitting and adjustment of other devices
Excludes: issue of repeat prescription only ( Z76.0 )
malfunction or other complications of device - see Alphabetical Index
presence of prosthetic and other devices ( Z95-Z97 )
Z46.0 Fitting and adjustment of spectacles and contact lenses
Z46.1 Fitting and adjustment of hearing aid
Z46.2 Fitting and adjustment of other devices related to nervous system and special senses
Z46.3 Fitting and adjustment of dental prosthetic device
Z46.4 Fitting and adjustment of orthodontic device
Z46.5 Fitting and adjustment of ileostomy and other intestinal appliances
Z46.6 Fitting and adjustment of urinary device
Z46.7 Fitting and adjustment of orthopaedic device
Orthopaedic:
· brace
· cast
· corset
· shoes
Z46.8 Fitting and adjustment of other specified devices
Wheelchair
Z46.9 Fitting and adjustment of unspecified device

Z47 Other orthopaedic follow-up care
Excludes: care involving rehabilitation procedures ( Z50.- )
complication of internal orthopaedic devices, implants and grafts ( T84.- )
follow-up examination after treatment of fracture ( Z09.4 )
Z47.0 Follow-up care involving removal of fracture plate and other internal fixation device
Removal of:
· pins
· plates
· rods
· screws
Excludes: removal of external fixation device ( Z47.8 )
Z47.8 Other specified orthopaedic follow-up care
Change, checking or removal of:
· external fixation or traction device
· plaster cast
Z47.9 Orthopaedic follow-up care, unspecified

Z48 Other surgical follow-up care
Excludes: attention to artificial openings ( Z43.- )
fitting and adjustment of prosthetic and other devices ( Z44-Z46 )
follow-up examination after:
· surgery ( Z09.0 )
· treatment of fracture ( Z09.4 )
orthopaedic follow-up care ( Z47.- )
Z48.0 Attention to surgical dressings and sutures
Change of dressings
Removal of sutures
Z48.8 Other specified surgical follow-up care
Z48.9 Surgical follow-up care, unspecified

Z49 Care involving dialysis
Includes: dialysis preparation and treatment
Excludes: renal dialysis status ( Z99.2 )
Z49.0 Preparatory care for dialysis
Z49.1 Extracorporeal dialysis
Dialysis (renal) NOS
Z49.2 Other dialysis
Peritoneal dialysis

Z50 Care involving use of rehabilitation procedures
Excludes: counselling ( Z70-Z71 )
Z50.0 Cardiac rehabilitation
Z50.1 Other physical therapy
Therapeutic and remedial exercises
Z50.2 Alcohol rehabilitation
Z50.3 Drug rehabilitation
Z50.4 Psychotherapy, not elsewhere classified
Z50.5 Speech therapy
Z50.6 Orthoptic training
Z50.7 Occupational therapy and vocational rehabilitation, not elsewhere classified
Z50.8 Care involving use of other rehabilitation procedures
Tobacco rehabilitation
Training in activities of daily living [ADL] NEC
Z50.9 Care involving use of rehabilitation procedure, unspecified
Rehabilitation NOS

Z51 Other medical care
Excludes: follow-up examination after treatment ( Z08-Z09 )
Z51.0 Radiotherapy session
Z51.1 Chemotherapy session for neoplasm
Z51.2 Other chemotherapy
Maintenance chemotherapy NOS
Excludes: prophylactic chemotherapy for immunization purposes ( Z23-Z27 , Z29.- )
Z51.3 Blood transfusion without reported diagnosis
Z51.4 Preparatory care for subsequent treatment, not elsewhere classified
Excludes: preparatory care for dialysis ( Z49.0 )
Z51.5 Palliative care
Z51.6 Desensitization to allergens
Z51.8 Other specified medical care
Excludes: holiday relief care ( Z75.5 )
Z51.9 Medical care, unspecified

Z52 Donors of organs and tissues
Excludes: examination of potential donor ( Z00.5 )
Z52.0 Blood donor
Blood components such as lymphocytes, platelets or stem cells
Z52.1 Skin donor
Z52.2 Bone donor
Z52.3 Bone marrow donor
Z52.4 Kidney donor
Z52.5 Cornea donor
Z52.6 Liver donor
Z52.7 Heart donor
Z52.8 Donor of other organs and tissues
Z52.9 Donor of unspecified organ or tissue
Donor NOS

Z53 Persons encountering health services for specific procedures, not carried out
Excludes: immunization not carried out ( Z28.- )
Z53.0 Procedure not carried out because of contraindication
Z53.1 Procedure not carried out because of patient's decision for reasons of belief and group pressure
Z53.2 Procedure not carried out because of patient's decision for other and unspecified reasons
Z53.8 Procedure not carried out for other reasons
Z53.9 Procedure not carried out, unspecified reason

Z54 Convalescence
Z54.0 Convalescence following surgery
Z54.1 Convalescence following radiotherapy
Z54.2 Convalescence following chemotherapy
Z54.3 Convalescence following psychotherapy
Z54.4 Convalescence following treatment of fracture
Z54.7 Convalescence following combined treatment
Convalescence following any combination of treatments classified to Z54.0-Z54.4
Z54.8 Convalescence following other treatment
Z54.9 Convalescence following unspecified treatment