2025 ICD-10-CM code Z91.13
(Active) Effective Date: N/A Revision Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Factors influencing health status and contact with health services (Z00-Z99) Feed
Patient's unintentional underdosing of medication regimen.
Modifiers are not typically applicable to Z91.13. This code represents a circumstance rather than a specific procedure or service.
Medical necessity for Z91.13 is established by the documentation of the unintentional underdosing itself.The code reflects a circumstance affecting the patient's health and healthcare interaction.No specific clinical impact beyond the underdosing is required for code assignment.
The clinical responsibility involves documenting the patient's unintentional underdosing, identifying the specific medication, and clarifying the reason for the underdosing, if possible.The physician or other healthcare professional should ensure accurate documentation to support the use of this code.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z91.13 falls under the broader category of Z91 (Personal risk factors, not elsewhere classified) and further specifies unintentional underdosing.
In simple words: This code means the patient accidentally took less medicine than the doctor prescribed.This code is used along with another code that identifies the specific medicine and the reason for the underdosing. It doesn't include situations where the patient followed the instructions but still had problems.
This code is used to indicate that a patient unintentionally took less medication than prescribed.It is crucial to note that this code should be used in conjunction with codes from categories T36-T50 (underdosing of medication) with a fifth or sixth character of "6".This code does not encompass adverse effects from prescribed drugs taken as directed; those should be coded as adverse effect poisoning.Furthermore, it excludes caregiver noncompliance, which should be coded using codes from category Z91.A-.If applicable, identify the specific underdosed drug using codes T36-T50 with the final character being "6".
Example 1: A 70-year-old patient with dementia forgets to take her prescribed hypertension medication several times a week, resulting in unintentional underdosing.Code Z91.13 would be used along with codes specifying the medication and any resulting complications., An elderly patient with impaired vision accidentally misinterprets the dosage instructions, leading to unintentional underdosing of her diabetes medication.This necessitates the use of Z91.13 and supplementary codes reflecting the specific medication and related issues., A patient with a complex medication regimen experiences an unintentional underdosing due to difficulty managing their medications. Z91.13 is used along with relevant medication codes and potentially codes related to medication management difficulties.
The medical record must clearly document that the patient unintentionally took a lower dose of medication than prescribed.Documentation should identify the specific medication(s) involved and the reason for the underdosing, if known.If possible, quantify the extent of the underdosing.
** While documentation of a change in the patient's condition isn't mandatory for assigning Z91.13, documenting any adverse effects or complications resulting from the underdosing will improve the completeness of the medical record. This is especially important for quality assurance and treatment follow-up.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Internal Medicine, Family Medicine, Geriatrics, Cardiology, Endocrinology, and other specialties where medication management is a significant factor.
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Skilled Nursing Facility, Home Healthcare