Is Z45.811 a billable ICD-10-CM code?

Yes. Z45.811 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z45.811 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Encounters for other specific health care (Z40-Z53).

What cannot be coded together with Z45.811?

Z45.811 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 Z45.811 (Z45.81, Z45) and apply to it just the same.

Z45.811

Z45.811 — Encounter for adjustment or removal of right breast implant

Billable / specific codeICD-10-CMPOA exemptright

Z45.811 is a billable, specific ICD-10-CM code for encounter for adjustment or removal of right breast implant. It is valid for submission on a claim.

Excludes1 inherited from the categories above Z45.811

These are not written on Z45.811, but they bind it: a note on a category applies to every code beneath it. Billing Z45.811 with anything listed here is a denial.

Written on Z45.81 — Encounter for adjustment or removal of breast implant

complications of breast implant (T85.4-)
encounter for initial breast implant insertion for cosmetic breast augmentation (Z41.1)
encounter for breast reconstruction following mastectomy (Z42.1)

Written on Z45 — Encounter for adjustment and management of implanted device

malfunction or other complications of device - see Alphabetical Index

Excludes2 inherited from the categories above Z45.811

Also inherited, and the opposite of Excludes1: these conditions are not part of Z45.811, but a patient can have both, so you may code both.

Written on Z45 — Encounter for adjustment and management of implanted device

encounter for fitting and adjustment of non-implanted device (Z46.-)

Risk adjustment

Z45.811 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.

Medicare coverage

Z45.811 is named in 6 Medicare coverage policies — 6 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56587Billing and Coding: Cosmetic and Reconstructive Surgery
A56658Billing and Coding: Cosmetic and Reconstructive Surgery
A57221Billing and Coding: Plastic Surgery
A58573Billing and Coding: Cosmetic and Reconstructive Surgery

Code history

Z45.811 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share Z45.81. If Z45.811 is not quite right, the correct code is usually one of these.

Questions about Z45.811

Is Z45.811 a billable ICD-10-CM code?: Yes. Z45.811 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z45.811 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Encounters for other specific health care (Z40-Z53).
What cannot be coded together with Z45.811?: Z45.811 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 Z45.811 (Z45.81, Z45) and apply to it just the same.