ICD-10 Coding for Medical Noncompliance(Z91.120, Z91.14)
Complete ICD-10-CM coding and documentation guide for Medical Noncompliance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Medical Noncompliance
Z91.1Primary Range
Patient's noncompliance with medical treatment and regimen
This range covers various reasons for noncompliance, including financial hardship, intentional underdosing, and other specified reasons.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z91.120 | Patient's intentional underdosing of medication regimen due to financial hardship | Use when the patient deliberately reduces medication intake due to financial constraints. |
|
| Z91.14 | Patient's other noncompliance with medication regimen | Use when the patient is noncompliant for reasons other than financial hardship. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for medical noncompliance
Essential facts and insights about Medical Noncompliance
Primary ICD-10-CM Codes for medical noncompliance
Decision Criteria
documentation Criteria
- Patient's statement about medication cost issues
Applicable To
- Intentional underdosing due to cost
Excludes
- Noncompliance due to forgetfulness
Clinical Validation Requirements
- Documented patient statement about cost barriers
- Pharmacy records showing unfilled prescriptions
Code-Specific Risks
- Misclassification if financial hardship is not documented
Coding Notes
- Ensure financial hardship is explicitly documented.
Z91.14 - Patient's other noncompliance with medication regimen
Use when the patient is noncompliant for reasons other than financial hardship.
Applicable To
- Intentional nonadherence for reasons other than financial
Excludes
- Noncompliance due to financial hardship
Clinical Validation Requirements
- Patient's statement about nonadherence reasons
- Medication reconciliation showing dose variance
Coding Notes
Ensure specific reasons for noncompliance are documented.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Medical Noncompliance to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z91.120.
Impact
Clinical: Impacts treatment decisions., Regulatory: May lead to audit issues., Financial: Can result in denied claims.
Mitigation Strategy
Use specific language in documentation., Link noncompliance to clinical outcomes.
Impact
Reimbursement: May lead to denied claims or lower reimbursement., Compliance: Noncompliance with coding guidelines., Data Quality: Decreases the accuracy of patient records.
Mitigation Strategy
Use specific codes such as Z91.120 or Z91.14 based on documented reasons.
Impact
Coding noncompliance without linking to clinical outcomes.
Mitigation Strategy
Ensure documentation links noncompliance to clinical outcomes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Medical Noncompliance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Medical Noncompliance
Use these documentation templates to ensure complete and accurate documentation for Medical Noncompliance. These templates include all required elements for proper coding and billing.
Patient with medication noncompliance due to financial hardship
Specialty: General PracticeRequired Elements
- Patient statement about cost barriers
- Medication reconciliation
- Clinical impact of noncompliance
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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