Is Z16.3 a billable ICD-10-CM code?

No. Z16.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does Z16.3 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Resistance to antimicrobial drugs (Z16).

What cannot be coded together with Z16.3?

Z16.3 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Z16.3 (Z16) and apply to it just the same.

Z16.3

Z16.3 — Resistance to other antimicrobial drugs

Non-billable headerICD-10-CM

Z16.3 is a non-billable header ICD-10-CM code for resistance to other antimicrobial drugs. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

resistance to antibiotics (Z16.1-, Z16.2-)

Excludes1 inherited from the categories above Z16.3

These are not written on Z16.3, but they bind it: a note on a category applies to every code beneath it. Billing Z16.3 with anything listed here is a denial.

Written on Z16 — Resistance to antimicrobial drugs

Methicillin resistant Staphylococcus aureus infection (A49.02)
Methicillin resistant Staphylococcus aureus pneumonia (J15.212)
Sepsis due to Methicillin resistant Staphylococcus aureus (A41.02)

Risk adjustment

Z16.3 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

Z16.3 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead Z16.3

7 child codes. Green means billable.

Related codes at this level

Codes that share Z16. If Z16.3 is not quite right, the correct code is usually one of these.

Questions about Z16.3

Is Z16.3 a billable ICD-10-CM code?: No. Z16.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does Z16.3 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Resistance to antimicrobial drugs (Z16).
What cannot be coded together with Z16.3?: Z16.3 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Z16.3 (Z16) and apply to it just the same.