ICD-10 Coding for Noncompliance(Z91.120, T46.1X6A)
Complete ICD-10-CM coding and documentation guide for Noncompliance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Noncompliance
Z91.1Primary Range
Patient's noncompliance with medical treatment and regimen
This range includes codes for various reasons of noncompliance, such as financial hardship or age-related issues.
Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
These codes are used to specify the effects of underdosing due to noncompliance.
Persons with potential health hazards related to socioeconomic and psychosocial circumstances
These codes are used to document social determinants of health that may contribute to 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 a patient intentionally reduces medication intake due to financial constraints. |
|
| T46.1X6A | Underdosing of antihypertensive drugs, initial encounter | Use when there is documented underdosing of antihypertensive medication. |
|
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 noncompliance due to financial hardship
Essential facts and insights about Noncompliance
Primary ICD-10-CM Codes for non compliance
Decision Criteria
documentation Criteria
- Document patient's statement about financial difficulty affecting medication adherence.
Applicable To
- Financial hardship leading to reduced medication intake
Excludes
- Noncompliance due to forgetfulness (Z91.138)
Clinical Validation Requirements
- Documented financial hardship
- Patient statement of reducing medication due to cost
Code-Specific Risks
- Misclassification if financial hardship is not documented
Coding Notes
- Ensure financial hardship is clearly documented in the patient's record.
T46.1X6A - Underdosing of antihypertensive drugs, initial encounter
Use when there is documented underdosing of antihypertensive medication.
Applicable To
- Underdosing of antihypertensives
Excludes
- Overdose of antihypertensives (T46.1X1A)
Clinical Validation Requirements
- Documented reduction in prescribed dose
- Clinical evidence of underdosing effects
Coding Notes
Sequence after the condition code and Z91.1x code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other problems related to housing and economic circumstances
Z59.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Patient's unintentional underdosing of medication regimen due to age-related debility
Z91.138Poisoning by antihypertensive drugs, accidental (unintentional), initial encounter
T46.1X1ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting 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: Inaccurate patient management, Regulatory: Increased audit risk, Financial: Potential reimbursement issues
Mitigation Strategy
Train staff on documentation standards, Use templates to ensure completeness
Impact
Reimbursement: May lead to lower reimbursement due to lack of specificity., Compliance: Increases risk of audit failure., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always document the specific reason for noncompliance and use the corresponding specific code.
Impact
Audits may target unspecified noncompliance codes.
Mitigation Strategy
Use specific codes and document reasons clearly.
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 Noncompliance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Noncompliance
Use these documentation templates to ensure complete and accurate documentation for Noncompliance. These templates include all required elements for proper coding and billing.
Patient with diabetes noncompliant due to financial hardship
Specialty: EndocrinologyRequired Elements
- Patient statement
- Financial assessment
- Impact on condition
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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