ICD-10 Coding for Noncompliance with Medication Regimen(Z91.120, Z91.141)
Complete ICD-10-CM coding and documentation guide for Noncompliance with Medication Regimen. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Noncompliance with Medication Regimen
Z91.12-Z91.13Primary Range
Noncompliance with medication regimen
This range includes codes for intentional and unintentional noncompliance with medication regimens.
Noncompliance with medication regimen due to financial hardship or other reasons
This range specifies noncompliance due to financial or 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 | Use when the patient intentionally reduces or skips medication doses. |
|
| Z91.141 | Patient's noncompliance with medication regimen due to financial hardship | Use when noncompliance is due to financial constraints. |
|
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 with medication regimen
Essential facts and insights about Noncompliance with Medication Regimen
Primary ICD-10-CM Codes for noncompliance with medication regimen
Decision Criteria
clinical Criteria
- Patient reports intentional reduction of medication dosage.
Applicable To
- Intentional underdosing of medication
Excludes
- Unintentional underdosing (Z91.130)
Clinical Validation Requirements
- Patient statement indicating intentional underdosing
- Clinical correlation with worsening condition
Code-Specific Risks
- Misinterpretation of patient intent
Coding Notes
- Ensure documentation clearly states the patient's intent.
Z91.141 - Patient's noncompliance with medication regimen due to financial hardship
Use when noncompliance is due to financial constraints.
Applicable To
- Noncompliance due to inability to afford medication
Excludes
- Noncompliance for other reasons (Z91.148)
Clinical Validation Requirements
- Patient statement about financial difficulty
- Documentation of financial assessment
Coding Notes
Ensure financial hardship is documented as the primary reason for noncompliance.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Adverse effects of drugs
T36-T50Differential 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 Noncompliance with Medication Regimen to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z91.120.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential loss of reimbursement.
Mitigation Strategy
Use specific patient quotes, Document reasons and plans
Impact
Reimbursement: May affect DRG assignment and reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces specificity and accuracy of health records.
Mitigation Strategy
Use specific codes like Z91.141 or Z91.148 when reasons are documented.
Impact
Using general noncompliance codes without specific reasons.
Mitigation Strategy
Ensure documentation includes specific reasons for noncompliance.
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 Medication Regimen, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Noncompliance with Medication Regimen
Use these documentation templates to ensure complete and accurate documentation for Noncompliance with Medication Regimen. These templates include all required elements for proper coding and billing.
Patient with chronic condition noncompliant due to financial reasons
Specialty: Internal MedicineRequired Elements
- Patient statement on financial hardship
- Medication review
- Plan for financial assistance
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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