2025 ICD-10-CM code Z91.19
(Revised) 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 Chapter 21: Factors influencing health status and contact with health services Feed
Patient's noncompliance with medical treatment and regimen.
No modifiers are typically used with Z91.19.
The medical necessity for coding Z91.19 lies in its ability to provide comprehensive information about the patient's care, facilitating improved treatment planning and resource allocation.It highlights factors impacting the effectiveness of interventions and helps to justify the need for further medical management and potentially additional resources to improve adherence.
The physician's responsibility includes documenting the patient's noncompliance, exploring the reasons for it, and adjusting the treatment plan as needed to improve adherence.This may involve patient education, addressing social determinants of health (such as financial constraints), and collaborating with other healthcare professionals.
- Chapter 21: Factors influencing health status and contact with health services
- Z91.19 is under the broader category Z91 (Personal risk factors, not elsewhere classified) and further divided into subcategories Z91.190, Z91.198, and Z91.199 to specify the reason for noncompliance.
In simple words: This code means the patient didn't follow the doctor's orders for their treatment. This could be for many reasons, and it's important to note because it affects their care.
This code signifies a patient's failure to adhere to prescribed medical treatment or regimens.It encompasses various reasons for noncompliance and should be used when the non-adherence significantly impacts the patient's health status or treatment plan.This code is not to be used if the reason for noncompliance is solely due to caregiver noncompliance.As of October 1, 2023, this code has been expanded to include more specific subcategories: Z91.190 (due to financial hardship), Z91.198 (for other reasons), and Z91.199 (unspecified reason).
Example 1: A diabetic patient consistently fails to monitor their blood sugar levels and does not adhere to their prescribed medication regimen.This results in frequent hospitalizations and poor glycemic control. Z91.19 would be coded in addition to codes for the resulting complications (e.g., hyperglycemic crisis)., A patient with hypertension consistently misses their medication appointments and refuses to make lifestyle changes, resulting in uncontrolled blood pressure. Z91.19 is coded along with codes for hypertension and any resulting complications., A cancer patient stops chemotherapy due to the associated side effects and financial hardship.In this case, Z91.190 would be used in addition to codes related to the cancer diagnosis and treatment.
Documentation should include: * Specific details of the prescribed medical treatment and regimen* Evidence of the patient's noncompliance (e.g., missed appointments, medication non-adherence, failure to follow lifestyle modifications)* Attempts made by the physician to improve patient adherence* Reasons for noncompliance, if known (this is crucial for selecting the appropriate subcategory – Z91.190, Z91.198, or Z91.199)* Any resulting complications or exacerbations of the underlying medical condition
** This code is frequently used in conjunction with codes for Evaluation and Management (E/M) services, particularly when the noncompliance significantly impacts the complexity of the patient's care.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:All specialties.
- Place of Service:Office, Hospital (Inpatient and Outpatient), Urgent Care, other relevant settings.