ICD-10 Coding for Medication Noncompliance(Z91.120, Z91.130)
Complete ICD-10-CM coding and documentation guide for Medication Noncompliance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Medication Noncompliance
Z91.1-Z91.19Primary Range
Personal history of noncompliance with medical treatment and regimen
This range includes codes for documenting noncompliance with prescribed medication regimens, both intentional and unintentional.
Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
This range is used to document adverse effects and underdosing related to medication noncompliance.
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 intentionally reduces medication dosage due to financial constraints. |
|
| Z91.130 | Patient's unintentional underdosing of medication regimen | Use when the patient unintentionally reduces medication dosage due to cognitive or physical limitations. |
|
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 medication noncompliance
Essential facts and insights about Medication Noncompliance
Primary ICD-10-CM Codes for medication noncompliance
Decision Criteria
clinical Criteria
- Patient reports skipping doses to save money.
documentation Criteria
- Pharmacy records indicate delayed refills.
Applicable To
- Intentional underdosing due to cost
Excludes
- Unintentional underdosing (Z91.13-)
Clinical Validation Requirements
- Patient statement of financial difficulty
- Pharmacy records showing delayed refills
Code-Specific Risks
- Assuming financial hardship without patient confirmation
Coding Notes
- Ensure documentation clearly states the patient's financial hardship as the reason for underdosing.
Z91.130 - Patient's unintentional underdosing of medication regimen
Use when the patient unintentionally reduces medication dosage due to cognitive or physical limitations.
Applicable To
- Unintentional underdosing due to cognitive impairment
Excludes
- Intentional underdosing (Z91.12-)
Clinical Validation Requirements
- Documentation of cognitive impairment or physical limitations
- Caregiver reports or medication logs
Coding Notes
Ensure documentation includes evidence of cognitive or physical limitations.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Underdosing of drugs, medicaments and biological substances
T36-T50.6Differential 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 Medication 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: Leads to inaccurate patient records., Regulatory: May result in audit discrepancies., Financial: Potential for denied claims.
Mitigation Strategy
Always confirm noncompliance with the patient., Document specific reasons for noncompliance.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in audit findings for inaccurate coding., Data Quality: Impacts the accuracy of patient records.
Mitigation Strategy
Document explicit patient statements or clinical evidence of noncompliance.
Impact
Noncompliance codes should not be used as the principal diagnosis.
Mitigation Strategy
Educate coding staff on proper sequencing rules.
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 Medication Noncompliance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Medication Noncompliance
Use these documentation templates to ensure complete and accurate documentation for Medication Noncompliance. These templates include all required elements for proper coding and billing.
Patient intentionally underdoses due to financial hardship
Specialty: General MedicineRequired Elements
- Patient statement of financial difficulty
- Pharmacy refill records
- Clinical impact of underdosing
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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