ICD-10 Coding for Noncompliance with Medication(Z91.120, Z91.130)
Complete ICD-10-CM coding and documentation guide for Noncompliance with Medication. 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
Z91.1Primary Range
Patient's noncompliance with medical treatment and regimen
This range includes codes for documenting reasons for noncompliance with medication, such as intentional or unintentional underdosing.
Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
These codes are used to document underdosing of specific medications and should be sequenced after the condition code.
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 intake due to financial constraints. |
|
| Z91.130 | Patient's unintentional underdosing of medication regimen due to age-related debility | Use when the patient unintentionally reduces medication intake due to cognitive issues. |
|
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
Essential facts and insights about Noncompliance with Medication
Primary ICD-10-CM Codes for noncompliance with medication
Decision Criteria
documentation Criteria
- Document the patient's statement about financial hardship and reduced medication intake.
Applicable To
- Intentional underdosing due to cost
Excludes
- Noncompliance due to forgetfulness (Z91.130)
Clinical Validation Requirements
- Documented patient statement of financial hardship
- Evidence of reduced medication intake
Code-Specific Risks
- Misclassification if financial hardship is not documented
Coding Notes
- Ensure financial hardship is clearly documented in the patient's record.
Z91.130 - Patient's unintentional underdosing of medication regimen due to age-related debility
Use when the patient unintentionally reduces medication intake due to cognitive issues.
Applicable To
- Unintentional underdosing due to forgetfulness
Excludes
- Intentional underdosing (Z91.120)
Clinical Validation Requirements
- Patient history indicating forgetfulness or cognitive impairment
- Documentation of reduced medication intake
Coding Notes
Ensure cognitive impairment or forgetfulness is documented in the patient's record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Noncompliance with Medication 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 inadequate treatment adjustments., Regulatory: May result in audit findings., Financial: Can cause claim denials or reduced reimbursement.
Mitigation Strategy
Use specific language to describe noncompliance reasons., Ensure documentation is complete and detailed.
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines may result in audit issues., Data Quality: Using outdated codes affects the accuracy of health records.
Mitigation Strategy
Always verify the latest ICD-10 updates and use the most specific codes available.
Impact
Using non-specific codes for noncompliance can trigger audits.
Mitigation Strategy
Ensure documentation supports the use of specific codes.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Noncompliance with Medication
Use these documentation templates to ensure complete and accurate documentation for Noncompliance with Medication. These templates include all required elements for proper coding and billing.
Patient with CHF reducing diuretic intake due to job interference
Specialty: Primary CareRequired Elements
- Medication name and dose
- Adherence percentage
- Reason for noncompliance
- Impact on health
- Patient education provided
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Noncompliance with Medication? Ask your questions below.