Is Z97.13 a billable ICD-10-CM code?

Yes. Z97.13 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z97.13 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).

What cannot be coded together with Z97.13?

Z97.13 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 Z97.13 (Z97) and apply to it just the same.

Z97.13

Z97.13 — Presence of artificial right leg (complete) (partial)

Billable / specific codeICD-10-CMPOA exemptright

Z97.13 is a billable, specific ICD-10-CM code for presence of artificial right leg (complete) (partial). It is valid for submission on a claim.

Excludes1 inherited from the categories above Z97.13

These are not written on Z97.13, but they bind it: a note on a category applies to every code beneath it. Billing Z97.13 with anything listed here is a denial.

Written on Z97 — Presence of other devices

complications of internal prosthetic devices, implants and grafts (T82-T85)

Excludes2 inherited from the categories above Z97.13

Also inherited, and the opposite of Excludes1: these conditions are not part of Z97.13, but a patient can have both, so you may code both.

Written on Z97 — Presence of other devices

fitting and adjustment of prosthetic and other devices (Z44-Z46)
presence of cerebrospinal fluid drainage device (Z98.2)

Other codes that can never be billed with Z97.13

These codes carry an Excludes1 note pointing at Z97.13. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Z97.13 alone.

Z18Retained foreign body fragments
Z44Encounter for fitting and adjustment of external prosthetic device

Risk adjustment

Z97.13 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 409 Amputation Status, Lower Limb/Amputation Complications0.598 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

Z97.13 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A53065Billing and Coding: Outpatient Physical Therapy

Code history

Z97.13 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 Z97.1. If Z97.13 is not quite right, the correct code is usually one of these.

Questions about Z97.13

Is Z97.13 a billable ICD-10-CM code?: Yes. Z97.13 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z97.13 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
What cannot be coded together with Z97.13?: Z97.13 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 Z97.13 (Z97) and apply to it just the same.