2025 ICD-10-CM code Z65.3
Problems related to other legal circumstances.
Medical necessity is established by the connection between the legal circumstance and the patient's health status.The provider should document how the legal issue is impacting the patient's physical or mental health, justifying the need for healthcare intervention.
The healthcare provider's responsibility is to document the patient's problem related to the legal circumstance and any impact on their health status.A procedure code must also be used if a procedure is performed.
- Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
- Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65)
In simple words: This code is used when a patient seeks healthcare services due to problems related to legal issues, such as being arrested, involved in a child custody case, or other legal proceedings.
This code is used to document problems related to legal circumstances other than conviction, imprisonment, or release from prison, such as arrest, child custody or support proceedings, litigation, or prosecution.
Example 1: A patient presents to their physician complaining of stress and anxiety due to an ongoing child custody dispute. The physician documents the patient's symptoms and the related legal issue., A patient is seen in the emergency room after experiencing an anxiety attack following their arrest. The physician documents the anxiety attack and the precipitating event (arrest)., A patient reports to their therapist that they are experiencing difficulty sleeping and concentrating due to an upcoming court case. The therapist documents these symptoms and their relation to the legal proceedings.
Documentation should clearly link the patient's health issue to the legal circumstance. The specific legal issue (e.g., arrest, litigation, child custody) should be documented. Any symptoms or conditions resulting from the legal issue should also be documented.
** This code is exempt from the Present on Admission (POA) reporting requirement.
- Payment Status: Active
- Specialties:Primary care, mental health, emergency medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital,Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home