2025 ICD-10-CM code Z65.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Social Determinants of Health - Persons with potential health hazards related to socioeconomic and psychosocial circumstances Chapter 21: Factors influencing health status and contact with health services Feed
Imprisonment and other incarceration.
Z codes are not typically modified.
Medical necessity for services rendered to incarcerated individuals must be clearly justified.This might involve demonstrating a direct link between the individual's incarceration and the reason for the healthcare encounter, such as managing a pre-existing condition or treating an injury sustained while incarcerated.Payer specific guidelines should be consulted.
The clinical responsibility will vary depending on the healthcare setting and the patient's needs. It may include providing routine medical care, managing chronic conditions, addressing mental health concerns, and assessing and managing any injuries or illnesses that occur during incarceration.
- Chapter 21: Factors influencing health status and contact with health services
- Z65: Problems related to other psychosocial circumstances
In simple words: This code is used when someone is in jail or prison. It shows that their health might be affected by being incarcerated.
This ICD-10-CM code classifies encounters for individuals experiencing imprisonment or other forms of incarceration.It's used to document the circumstances impacting health status, not necessarily a disease or injury.A corresponding procedure code is required if a procedure is performed during the encounter.
Example 1: A 35-year-old male inmate presents with chest pain. The Z65.1 code is used to document his incarceration status while other codes specify the chest pain and any treatment provided., A 28-year-old female inmate with a history of depression requires a mental health evaluation and medication adjustment. The Z65.1 code documents her incarceration, while additional codes describe the psychiatric evaluation and prescription., A 40-year-old male inmate who has been recently released from prison presents to a clinic for follow-up care related to previously diagnosed hypertension. Z65.1 might be used in conjunction with a code reflecting his hypertension and follow-up care needs.
Documentation should include the patient's incarceration status, reason for encounter, relevant medical history, physical examination findings, diagnostic tests results, treatment provided, and any follow-up plans.This documentation should clearly demonstrate the medical necessity for the services provided.
** Z65.1 should be used cautiously and only when the incarceration directly relates to the reason for the healthcare encounter.It should not be used as a stand-alone code unless the encounter is solely for issues directly related to the incarceration itself.
- Payment Status: Active
- Modifier TC rule: Not applicable to Z codes.
- Specialties:Correctional healthcare, primary care, psychiatry, and other specialties as needed based on the patient's condition.
- Place of Service:Prison/Correctional Facility, Office, other appropriate settings for post-incarceration care.