ICD-10 · PDGM grouping
Z42 Encounter for plastic and reconstructive surgery following medical procedure or healed injury
All 2 codes in the Z42 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
2
Can lead a claim
0
Cannot lead a claim
2
What CMS assigns to Z42
None of the 2 codes is assigned a clinical group. None of the 2 is assigned a comorbidity subgroup. None can lead a claim.
Every code in Z42
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| Z42.1 | Encounter for breast reconstruction following mastectomy | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| Z42.8 | Encounter for other plastic and reconstructive surgery following medical procedure or healed injuryCMS: Encntr for oth plast/recnst surg fol med proc or heal injury | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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