2025 ICD-10-CM code Z76.0
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons encountering health services in other circumstances Chapter 21: Factors influencing health status and contact with health services Feed
Encounter for the issuance of a repeat prescription.
Modifiers are not applicable to ICD-10 codes. Modifiers are used with CPT and HCPCS codes.
Medical necessity is established by the previous diagnosis and the ongoing need for the prescribed medication to manage a chronic condition or prevent disease exacerbation.The documentation should support the ongoing need for the medication.
The clinical responsibility associated with this code is limited to verifying the patient's continued need for the medication and authorizing the refill.No additional clinical services are inherently included.
- Chapter 21: Factors influencing health status and contact with health services
- Z76 - Persons encountering health services in other circumstances
In simple words: This code is used when someone goes to the doctor or pharmacy just to get more of their regular medicine. It's not because they're sick or have a new problem; they just need a refill.
This code is used to classify encounters where the primary reason for the visit is to obtain a refill of a previously prescribed medication.It indicates that the patient is not seeking treatment for a new or worsening condition but rather routine medication replenishment.This code should be used in conjunction with a procedure code if a procedure was performed during the encounter.It is exempt from Present on Admission (POA) reporting requirements.
Example 1: A patient with hypertension visits their physician's office solely to obtain a refill of their blood pressure medication.No other medical concerns are addressed during the visit., A patient with a chronic condition, such as diabetes, visits their pharmacy to get a refill on their insulin prescription., A patient with stable asthma visits their physician's office to obtain a refill of their inhaler. The patient reports no change in symptoms.
Documentation should include the patient's medical record showing the previous prescription, the physician's order for the refill, and verification of the patient's identity.
** This code is used as a reason for encounter. A procedure code is required if a procedure was performed.This code is exempt from Present on Admission (POA) reporting.
- Revenue Code: Revenue codes will vary depending on the payer and the specific services provided. Consult your payer's guidelines for the appropriate revenue codes.
- RVU: RVUs are not applicable to ICD-10 codes. RVUs are used for CPT codes to determine reimbursement.
- Global Days: Not applicable to ICD-10 codes. Global periods apply to surgical procedures coded with CPT codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule: Not applicable to ICD-10 codes. Fee schedules apply to CPT and HCPCS codes.
- Specialties:This code can be used across multiple medical specialties depending on the medication prescribed.
- Place of Service:Office, Pharmacy